HomeMy WebLinkAboutMortgage_Cederholm oEs,:P STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
l�;,;;�;� County Township Year
\,, FOR DEDUCTION FROM ASSESSED VALUATION
"\ , ,f S1 State Form 43709(R14/1-20) Gibson o k 2020
e1 fi-`e 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. $ `�RI .runty Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is i
located on or before January 5 of the calendar year in which the property taxes are first due and payable. It,. E1 i':,n'A�order
See reverse side for additional instructions and qualifications. OCT`o `7
Applicant(.,r or c tract b er-s e restriction --reve side) i o 820
f y�
//7'J 1 , `�/ t 0,2 7G/e0 O /4466
axi fact Key u F legal des iptwn 1/ e (
Page number
Assessed value of real p or perty as oindebtedness unpaidtb -f Mortgage/Contract indebtedness unpaid as of Mortgage/Contract as of F l ppli . t the sole
assessment date,current year assessment date,current year date of application / Iega1 (E''. ble owner?
/Ov, (7 )d %Y s ❑No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is t property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(numbe and street,city,st e,and IP code)
Name of assignee or other owner or hold. - ;. ':age
i e.,. P (----) e.) 27(7.2--j° . (.1---19e
Address of assignee(number and stresta= =nd ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? auction
other county -
❑ ❑No
in Indiana? Yes
A person is not entitled to this deduction unless the person has a balance on the person: /1 1 e county
recorder's office(including any home equity line of credit that is recorded in the county re Drawer NO.... ....i2 U....
COUNTY AUDITOI
Deduction approved in the amount of: / I? / f „•
Card NO. (� JvIS1U
20 20 20 20
Signature of Cou itor .. County
/ y_ e.certif under-the penalty-of perjury that-the at, ye and fuTeyding information is true and correct and that the applicant is a resident of Indiana and
owner!co tract buyer of th aforemention d prop y n date application is filed.
Signal ner's ful name) Date(mon h,day,year)
.7%* AM 1/Pfi0
II re7t d ss of app' numbe gpd str , 1, at an ZI code)
, rp?;i7
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 nenalties for neriury can include imnrisonment un In twn and a half years and a fine not to exceed Sin non.