HomeMy WebLinkAboutMortgage_Hyneman (5) �.50�-;, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
1l 72': ii FOR DEDUCTION FROM ASSESSED VALUATION
~..., Ai' State Form 43709(R14/1-20) n,� 02 y 20r)r
'•••----•• Prescribed by Department of Local Government Finance JJ (� �1J
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File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form filed with:
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Filing Date: Form must be completed and dated in the calends ear 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 the
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Taxing District ou Key number/legal description Record number 'Page number
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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 p a on ^ legal ore uitable owner?
d� Yes El No
If no,what is his/her exact share of interest? If owned with so eone 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)
Name of mortgagee or contract seller ` _ �( r l ^ ri _
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Address of mortgagee or contract seller(number and street,city,state,a ZIP code) >--1
Name of assignee or other owner or holder of mortgage O C T 2 8 2020
Address of assignee(number and street,city,state,and ZIP code)
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Does applicant own property in any If yes,what county? What Taxing District? Has this deductjgr eke a V j -�fiem l t of deduction
other county on property for l`-3
in Indiana? ❑Yes ❑No current year? Yes ❑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
Signature of County Auditor ' County Date(month,day,year)
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II We certify under the penalty of perjury t artr�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.
XSignature(owne I ame) J Date(month,day,year)
Full resident a,dress of a cant(number and street,city,state,and ZIP code)
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Person authorized by duly execut ower 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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