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HomeMy WebLinkAboutMortgage_Phillips (7) 0EF,Te,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYears FOR DEDUCTION FROM ASSESSED VALUATION i "aJ'.`:�",'� State Form 43709(R14/1-20) /� 01 1 0214 / (�2O F_...-;ti=-.=,, Prescribed by Department of Local Government Finance '3 (�VVV !/� �eie File 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. County 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. Applicant(owner or contract buyer-see restrictions on reverse e ` —. .t 'A Ci 11 e,l \\\'� S T ing District Key number/leg description Record number Ps num er Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indeb edness unpaid as of Is the a licant the sole assessment date,current year assessment date,current year date of application ( I ,, legal or ' ble owner? —V `'1�I LQ OQ Yes ❑No If no,what is his/her exact share of interest? If owned with someone other'than spou e,indicate wi whom If name on record is different than that of applicant,indicate below: Is the pr erty in question:Annually Assessed BL.Re-al Pro erty ❑Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller ,r E\\ckx\ 0 1 1 (e_ c_Dt_...o, Ad . 6, , \k,„, „Pi Address of mortgagee or contract seller(number and street,city,state,and ZIP code) L ' iP 40, Name of assignee or other owner or holder of mortgage OV y ci Address of assignee(number and street,city,state,and ZIP code) /es° e0�0 Does applicant own property in an If yes,what county? What Taxing District? Has this deduction been r quested 1 r� aunt of deduction other county on property for in Indiana? ❑Yes o current year? es ❑No °qe, A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is ti�ded 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 deductio 5. COUNTY AUDITOR Deduction approved in the amount of: 20 20 20 20 20 20 20 Si ature of County Auditor Coun /\ Date(month,day,year) J1/4. e-4— . P ) "( 6.-V( [I — ( —,4©- 0 I/We certify under the pjAllN. y of perjury that the aboie an' ' --going information is true and correct and that the applicant is a resident of Indiana and owner/contract buyer of the aforementioned property on da'1"tu plication is filed. Signature(owners name) z Date(month,day,year) Full address of applicant(number and street,city,state,and ZIP code) Person authorized by duly executed Power 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) The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.