HomeMy WebLinkAboutMortgage_Fryman (2) -e STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
i'i .,;,-_,v Zvi . 2020
t.. �� State Form 43709(R13/10-15) CO�
;;,--V. Prescribed by Department of Local Government Finance J
Dais
INSTRUCTIONS: �Q` J ` File Mark
To be filed in person or by mail. l Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the lendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor r County Recorder of the county where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
A t(owner
�o/r/contract buy -see restrictions on ver e ide)$
Ta ing list t c/ Key num r/leg escn tion Record number Page n mb r
;, , � ' -�3 .001 I�0 Z,o20 gib .
--ssed value of r- eal property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
-ssment date,current year assessrpenrt1da ,cu r date of application legal or equitable owner?
i ❑ Yes El No
If no,what is his/her exact share of interest? 'If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑✓ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
of mortgagee r contra t s Iler
tal(VL( ° tvil,d --Atti-- ric6) FL fil , - 1--i- v
A s of ogageie o nt ller(numb nd stree city,s tri�an ZI(Pco )EO �' I. �f
-1D 1
Name of assignee or other owner or holder of mortgage
- -- - - -- — OCT 1 4 2020 -
Address of assignee(r
Does applicant own pn Vhat Taxing District? H requested If yes,state amount of deduction
other county pq ro f
in Indiana? CI ' ni AID YE Fn III Di
A person is not entith a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(incl kirecorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
atur (ow ers ful ame)yS.
_ to(month,day,year)
Fug t die s of li t umber a street,city,sta ,and Zip code)/ l
I
4-7039
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
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