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HomeMy WebLinkAboutMortgage_Lamey �E7,*s�. STATEMENT OF MORTGAGE OR CONTRACT INDE S •t Township Year �� ''�A. FOR DEDUCTION FROM ASSESSED VALUATION L ff\ rJ$ `ti.. State Form 43709(R14/1-20) f- Lj , ,• 0? �j/ 4`'�"--' Prescribed by Department of Local Government Finance F kifil OCT 0'9 2020 File Mark INSTRUCTIONS: To be filed in person or by maiL Form ' d with: Filing Date: Form must be completed and dated in the calendar year for which the deducti 's sough ounty Auditor Must be filed or postmarked with the County Auditor or County Recorder oft a property is located on or before January 5 of the calendar year in which the proPie r� ,5I1 oabblle.. ❑ County Recorder See reverse side for additional instructions and qualifications. /i ��11t�� Applicant(o .;.20 tract buyer-see res on n reve side Taxin suit Key number/legal es Aeon 1 Recor number Page number dd-d7 ' -Q500•-oo'./ - am.‘ ono ,1W ssed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole sessment date,current year assessment date,current year date of app ca l � ❑ legal or equitable owner? Yes III No If no,what is his/her exact share of interest? If owned with someone other if spouse,indicate with whom If name on record is different than that of applicant,indicate below: Is th roperty in question:Annually Assessed Real Property ['Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller 4;),& "214(11 Address of mortgagee or contract seller(number and street,city,state,and ZIP Name of assignee or other owner or holder of mortg a 7 2 .c„. / / I // ,,I.s% ,98 Address of assignee(number and street,city,sta ,a d code) Does applicant own property i ny If yes,what county? What Taxing District? Has this deduction been req, d If yes,state amount of deduction other county on property for in Indiana? El Yes No current year? ❑Yes NA , A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract inde• -•n 's tha�n s orded in the county recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basisTdre f ictia CT COUNTY AUDITOR 0 4.. Deduction approved in the amount of: / 09 020 •.20 20 20 20 20 C/eSp41 ' 2p, 20 Signature of o Auditor a County OU'vtpe onth,day,year) /l �U�OTppp /We certify unde a 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. Signature(owner's full name) Date(month,d y,yea Ful�eyytre�Gof3icant(numberand scree , at an code) `i_. •. / j,,y Person authorized� by duly executed ofof 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) The penalties for periury can include imprisonment up to two and a half years and a fine not to exceed$10,000.