HomeMy WebLinkAboutMortgage_Meadows (2) .�E�* STATEMENT OF MORTGAGE OR CONTRACT INDEBTED�. a Township Year
A \e FOR DEDUCTION FROM ASSESSED VALUATION ? s ~'
"� t <t;. State Form 43709(R14/1-20) �� fZ. . (9 2� 2020
'' '==' Prescribed by Department of Local Government Finance
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INSTRUCTIONS: To be filed in person or by mail. N O V 2 2020 File Mark
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. 0 County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county ` re'.40l.it y is
located on or before January 5 of the calendar year in which the property taxes are fir . .4'@' ❑ County Recorder
GIBSON OU 1 'It)
See reverse side for additional instructions and qualifications.
Applicant owner or contract buyer-see restrictions on reverse side)
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Taxing i trict Key number/legal description Record number Page number
` 026 —a l8 - /03 003. 115,2 -0 x 8
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 of application legal or equitable owner?
/7/1/ e0b ❑Yes ❑No
If no,what is his/her exact share of interest? If owned with someone other thbn spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
XReal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sel r
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) _
Name of assignee or other owner or holder of mortgage ( 1‘0
3, 6 .
Address of assignee(number and street,city,state,and ZIP code)
Drawer NO
Does applicant own property in any If yes,what county? What Taxing District? Has this deducti Qn D 3
C
other county on property for U ,11'd 1
in Indiana? ❑Yes No current year? N�'❑
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or co ___._ .,,a,,a,euuruea 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)
I,We certify under the penalty of perjury that the a ove of regoing information is true and correct and that the applicant is a resident of Indiana and
owner/c n)tract buyer of the aforem tioned property ate application is filed.
Signature(off full me) t— Date(month day,year)
Arl,aII resident alt�d ess app t(nu b r and street,city,state, ZIP code)
11
Pers0 authorized by duly executed Power of Attorney or by I 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 imprisonment LID to two and a half years and a fine not to exceed$10.000.