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HomeMy WebLinkAboutMortgage_Loyd ? t,f—F-4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESSCountyTownship �'\ Year ;1 .''''' FOR DEDUCTION FROM ASSESSED VALUATION ii -t;'1.`, 'i' State Form 43709(R14/1-20) Gibson 2020 a, -,. Prescribed by Department of Local Government Finance e7e v..e Mark INSTRUCTIONS: To be filed in person or by mail. r 1 led with: Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. '6 Co' u to 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 property taxes are first due and payable. p� ❑ Co y,R orar See reverse side for additional instructions and qualifications. Applicant( n r or co ract bu r- ee restrictions on r erse side) f 2020 Taxi g D' tric Key u ber/le I descric ion n �) Record rlU g l �6 -/Y/! — dd-oog. C/5/' 5" ao0a6 7-1 U e nugrflef�Y� Assess d value of realprop2 as of Mortgage/Contrac indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the a lican't'�� ole rtYPP PP assessment date,current year assessment date,current year date of application legal or equitable owner? �9 -CO n El Yes ❑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 Z?-r- ea Address of mortgagee or contract seller(number and street,city,state,and ZIP code) Name of assignee or other owner or hold ortga� � ,%6�� ����� ( V/ � o tt/ t Address of assignee(number and street,c/fate,and ZIP code) Does applicant, 1",‘--''r^-,--rlistrict? Has this deduction been requested If yes,state amount of deduction other county on property for in Indiana? current year? ❑Yes ❑No A person is no Dn the person's mortgage or contract indebtedness that is recorded in the county recorder's offic �Da� n the county recorder's office)that is the basis for the deduction. v Drawer NO INTYAUDITOR Deduction appr �� Card0 NO. 20 ) 20 20_ 20 I I I Signature of Auditos- ram,/, County Date(month,day,year) I/We certify under the pena ty 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. - Signature i wner's full name)/ / Date(month,day,year) Signature fn/% Full resident address of applicant(n mber and stree, state,and ZIP code) Persgoo ( a ize uly executed Power ofAttorney 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 penury can include imprisonment uo to two and a half years and a fine not to exceed$10,000.