HomeMy WebLinkAboutMortgage_Higdon r,,g ST,Tea. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
": -:>1 FOR DEDUCTION FROM ASSESSED VALUATION
I
"�^ ;� State Form 43709(R14/1-20) S'Oe\ O
. q
„„ Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form filed with:
Filing Date: Form must be completed and dated in the
_
Applica (owner or cOnti buyer` e res icnrerse side)
Taxing Dis (oct�,(Jltl/•, Key nu er/legal description 3 Record number P number
2�-iq-31 3 - c I�{2�-oo°I , 202� � �
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/ ntract indebtedness unpaid as of Is the ap licant the sole
assessment date,current year assessment date,current year date of ap t) ass legal or qui le owner?
��L�j /��/ es ❑No
If no,what is his/her exact share of interest? If owned with som ne other thin spouse,indicate with whom
If name on record is different than that of applicant,indicate below: I e property in question:Annually Assessed
E1 Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 51,k 3.....(6 1/04 r
• FIT E II,
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage 2�"'�
NOV 2
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 n r c l Res,state amount of deduction
other county '&hyeaf
in Indiana? ❑Yes El r es ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or c nt ct 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 2Z 20 20 20 20 20
Signature of County Auditor County 1—S ^ Datg(m nth,da,year)
ivi
-\(r\ v 1 t/ 12
,
I/We certify under the penalty of perjury that the above an oregoing information is tr and correct and that the applican is a re ident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signal e(owne s full name) Date(mo h,day, ear)
y,,, ,/ ` itfJL/kt,O
Fu sident ad s ppli n (number nd stre t,city,s t ,and Zl code) '
o �s �- an- (139
Person authorized by duly executed Power of Attorney6r 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 penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.