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HomeMy WebLinkAboutMortgage_Kavanagh j="�4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year � = FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R14/1-20) ( •a • © 1 2020 6-- Prescribed by Department of Local Government Finance Jk. f ° � tFDrk INSTRUCTIONS: To be filed in person or by mail. A filed with: Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. NO V 1 County Auditor Must be filed or postmarked with the County Auditor or County Recorder of the county where the propet iO20 located on or before January 5 of the calendar year in which the property taxes are first due rid payable. ❑ County Recorder See revers side for additional instructions a .qualifications. GitiSQN C Ap lic nt caner or contract buyer-see restri llt. on rev rse side) U�r' Li a / ®'TOR Ta ing 's icy ^ n Key be0legal,des ion Q �®DS./ 1 - 61a Record numberPa tuber ssessed value of rea propertyro - as of -SMMorttgaage/Contract indebtedness unpaid as of Mortgage//Contract indebtedness unpaid`aaJs of Is the pli nt the sole�� assessment date,current year assessment date,current year date of a licat�n legal or itable owner? f/`'V Yes ❑No If no,what is his/her exact share of interest? If owned wit someort( Cher 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 sell / ?2( Address of mortgagee or contract seller(number and street,city,state,and ZIP code) Name of assignee or.t'.1er or h er of moil.. p C_-YZ dg-/-// 1,4&, Address of assign-e(num.• and street,city,state,and ZIP code) Does applicant own proper Has this deductio bjen requested If yes,state amount of deduction other county on property for in Indiana? ❑Yes �� current year? Yes ❑No • A person is not entitled A '(3 0 son's mortgage or c ct indebtedness that is recorded in the county recorder's office(includir Drawer NO ty recorder's office) hatVs the basis for the deduction. Deduction approved in the; -'5 ITOR Card NO. 20 I 20 20 20 Signature of u Audito1 ".. County Date(month,day,year) I/We certify under thalty of perjury thaffeabove 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(owner' e) Date(month,day,year) O Full resident a�ddlress of applicant(number an street,city, e,a P code) � ��Z,�,I ni Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 /�W/ Date(month,day,year) Address of authorized person (number and street,city,state,and ZIP code) The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.