HomeMy WebLinkAboutMortgage_Mayer (7) . P� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.1"";-�.A FOR DEDUCTION FROM ASSESSED VALUATION
ai J'�':"' State Form 43709(R14/1-20
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a%•• Prescribed by Department of Local Government Finance '
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the calendar year in which
I I1c llOka0 1 \ . not
eA .
Taxing District hteb number/legal descriptia� Record number Page number
02s , 26 .- I -17^?-oo -ooLi_ ( 224 -021 ?�d7 _5 9
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as o Mortgage/Contract indebtedness unpaid as of Is the ap licant the sole
assessment date,current year assessment date,current year date of plicatio s— legal or 'table owner?P
I o6 O O� • Yes ❑No
If no,what is his/her exact share of interest? If owned with s meone othe/than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: t e property in question:Annually Assessed
Real Property ❑Annually Assessed
/\ Mobile Home(IC 6-1.1-7)
Name of mortgagee or ct selle
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assign FILE
Address of assi, O C T 1 9 2020
Does applicant! ct? Has this deduction en requested If yes,state amount of deduction
other county on property for �'
in Indiana? �7 , current year?
A person is no /v 1 he person's mortc�'�9 b�rghlitgPVil -66dr'a IDU aIiRrecorded in the county
recorder's offic " e county recorder's office)that is the basis for the deduction.
Y AUDITOR .
Deduction approved in me amount ot: •
20 111 OP0 20_ 20 20 20 20
Signature of County Aud . ,, County Date(month,day,year)
Uv11 �� 10 . 19•'vo2,o
I/We certify unde - 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.
X Signature(owner's full name) Date(month,day,year) ,
''r/guy ro. - 20 7.0
Full resident address of a li nt( mb r and street,city,state,_and IP code)
GLI6± W r6) O'vi\leOf ti-66_� -
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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.