HomeMy WebLinkAboutMortgage_Czoer friept. , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�'�% a FOR DEDUCTION FROM ASSESSED VALUATION
- n
. .L3. State Form 43709(R14/1-20) 4� - le /,O(60
;le Prescribed by Department of Local Government Finance 3.a t
i'Fil4 ,`i
INSTRUCTIONS: To be filed in person or by maiL A' s�Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. NOV V 1 fi �zcounty Auditor
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 ❑ County Recorder
See reverse side for additional instructions and qualifications. G!Bso „,., T
Applica .i ner or contract buyer- e restrictions on reverse side) n��)IOFF
Toxin• istric ,upber/legal desc lion Record number P e number
r79 20r)- 2S—.
A---ssed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the ap licant the sole
.,F�essment date,current year assessment date,current year date of application legal ore u' le owner?
/051/ Ofb Yes El No
If no,what is his/her exact share of interest? If owned with someone dther than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /4i �2,7
Address of mortgagee or contract seller(humber and s reef, ty,state,and ZIP code)
Name of assignee or other owner or I f mortga
if >77-)oP1 db67 di--,/ ,/y 6
Address of assignee(number an street, r state,and ZIP code)
Does applicant own property in any Is this deduction .een requested If yes,state amount of deduction
other coun
in Indiana?y ❑Yes III No rrp oe eprtyfor
year? I Yes ❑No
A person is not entitled to this d 190(�o /ortgage or c. t.:ct indebtedness that is recorded in the county
recorder's office(including any, Drawer NO �!1 rder's office)that i ..a basis for the deduction.
DaDeduction approved in the amount 3. 5_
Card NO. lJ///
20 20 20 20 20
Signature of Auditor — I I County Date(month,day,year)
I/We certify under the penalty of perjury th t above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer ••aforementioned prope on date application is filed.
XSignature(owneW Date(month,day,year)
Full residen a.dre r of appr-=nt(num.e and street,city(st•e, -nd ZIP co .) ��
_.4.%i,i_ ' /Ian . �/ ♦i%<
Person authorized by duly executed-ower 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)