HomeMy WebLinkAboutMortgage_Smith (45) v.:A 0. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
='<; .1, FOR DEDUCTION FROM ASSESSED VALUATION
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"� 1' ' State Form 43709(R14/1-20)
t. TOY\
:—, 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
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Applicant(owner or contract buyer-see resin or(s o everse sidle)'
Tax' District Key number/legal des Record number Page number
a6 -iL-0-1-`40I - oo1 _g.s-+ -o z. 11`2.0 y3q
Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortg=•- Contract indebtednes •npaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of app -dal legal r eq table owner?
g. 3Q 000 Yes ❑No
If no,what is his/her exact share of interest? If owned with someon-other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: s t property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller J Y V A
E'� ��`t
J �n 7 a.
Address of mortgagee or c tract seller(number and street,city,state,and ZIP code)
oa k f ,In -on- �R( OCT 1 2020
Name o assignee or other ner or holder of mortgage
µ
Address of assignee(number and street,city,state,and ZIP code) a , '
i rI �r��
Does applicant own property in any If yes,what county? ,. Wh Ta j�g D It? Has a tit:�uetld�n bLe1litAluesteSU !OP51'ete amount of deduction
other county � on property for
in Indiana? ❑Yes ❑No ti `i ., l current year? III Yes ❑No
A person is not entitled to this deductio t nl'ss lie p;j oa ha'a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home e 7'ty li . -"it that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 0 20 20 ` 20 20 20
Signature of County Auditor �� County 1 Date(month,day,year)
1/We certify under the p alty of perjury that the aC ove and foregoing information is tr a nd correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
all-ure(owner's full name Date(month,day,year)
Full resident-'ddress of applicant(number and tr t,city,state,and ZIP code)
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.