HomeMy WebLinkAboutMortgage_Price (8) l4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I" ►' •_ nip Year
FOR DEDUCTION FROM ASSESSED VALUATION i &>*.i , .,Wr
xi J: State Form 43709(R14/1-20) Gibson /• 2020
. !Deis Prescribed by Department of Local Government Finance •,i r
� 1 al 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. 0 County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county taQ D wry `Ty AU
located on or before January 5 of the calendar year in which the property taxes are first due and payable. SQL unty Recorder
See reverse side for additional instructions and qualifications.
Applica wner o ontract buyer s e restrittions on reverse side)
Taxi 'strict Key number/legal description Record number Page number
41. � (p -• //--od -/Dp - 000- 560 — o .47 . 0/ "2 V 99
Assessed value of real grope 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 o eq 'table owner?
l 9f o o O Yes ❑No
If no,what is his I 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 tpe property in question:Annually Assessed
X Real Property ❑Annually Assessed _
Name of mortgagee or contract sel er ( /
/ /, T I
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)/ Drawer 1 tT O.. 0 S
1.......
Name of assignee or other owner or holder of mortgage
(AO 1—
Card N1O•
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 this deduction bee equested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes No current year? es ❑No
A person is not entitled to t is deduction unless the person has a balance on the persons 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)
wvK;
I/We certify under the 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 a entioned property on date application is filed.
Signatur wne' lull n e) r Date(month,day,year)
Full reside dre of applicant(number street,city,state,and ZIP de)
/X` /a7'�' 4, �,/�''(y .-5/ ,/j/ ���
( Person authorized by duly executed Power of Attorney r6 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 nenaltiec fnr nerj,,n/ran inrlllrte imnri'nnment tin In twn and a half Vear.0 and a fine not to exceed Ron nnn.