Mortgage_Evans .MJ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship
o1,%.y- � Year
4 FOR DEDUCTION FROM ASSESSED VALUATION
" 1'e `ii
+ State Form 43709(R14/1-20) f��cr(\ 0�� %)V)
``=r=�4' Prescribed by Department of Local Government Finance 1 V
raie
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
J u.i anS.
Taxing District Key number/legal description R ord number Page number
C.2�- 2G- IZ-03-20n-od18G �—o2�-- . 020 . D3--1c
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as'of Is the applicant the sole
assessment date,current year assessment date,current year date o appli tion legal or 'table owner?
Z24{000^- , Yes ❑No
If no,what is his/her exact share of interest? If owned with s eone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: I th property in question:Annually Assessed
eal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contra eller�(6. e
Address of mortgagee or cant ct seller(number and street,city,sate,'nd ZIP code)
114 I 1 e,,-ID
.,...al,
Name of assignee or other owner or holder of mortgage
OCT 2 0 2020
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has thO.Jf yes,state amount of deduction
other county ❑ G ISIS Art Y 9t
in Indiana? Yes No current year? es No
❑
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded 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 basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of: •
20 20 20 20 20 20 20
lilt
Signature of County A • County Date(month,day,year)
') 10 -1,0
.'Lora-t3
I/We certify and-de h- 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(ow /s ful na e) Date(month,day,year)
/r! / / _ice_ (Q,20• �J� .
Full r 'den dbr of applic 't(n tuber and street,city,state,and ZIP code)
Person authorized by duly executed Pdver 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 ncnn/fiac f,r ncrL,n,rnn inrinrim imnncnnmanf It.fr he.n nnrl n hmlf,renrc n.,.r n Enc..,.,*i.,e....ee.r oin nnn