HomeMy WebLinkAboutMortgage_Glomski -44 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
;;<.$ FOR DEDUCTION FROM ASSESSED VALUATION Q r+-
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State Form 43709(R14/1-20)
4 „�o `�' Prescribed by Department of Local Government Finance Gibson
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. m 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. 0 County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
MOW ,- , C\t i-s2 t QM ,tam L. GlOrnStl
Taxing D}ylric a r Keyamber/legal riptio 0u _ o , I` _ ,{� — O 2� _ rd nyrgbeL P e number
Assessed value of real property as of Mortgage/&tract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is th a scant the sae'
assessment date,current year assessment date,current year date g,�p 00 V legal r equitable owner?
.�.7 ^ Yes ❑No
If no,what is his/her exact share of interest? If owned with someone otheAhan spouse,indicate with whom
If name on record is different than that of applicant,indicate below: I t e property in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mmo as eeee oar contractc alter
PCS` (rDb Vet 1 ` f A r
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) FILEk E Mo lit S\-. bIG1 :Z, cote W
Name of assignee or other owner or holder of mortgage
NOV 2 O 2020
Address of assignee(number and street,city,state,and ZIP code)
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Does applicant own property in any If yes,what county? What Taxing District? Has this dedu.Jf bee -- ' If yes,state amount of deduction
other county on property •it,
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in Indiana? ❑Yes 0 No curren W:UP! . iQ)'11TOR
A person is not entitled to this deduction unless the person has a balance on the person's mo gage 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 If 20 20 20 20
Signature of County Audito. -4\ County , Date(m th,day, ear)
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I/We certify unde p (I enal ofer1urY thaforegoing information is tnd correct and that the applicant i a resid[LQ —c
of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signal,re(owner's full name) Date(month,day,year)
Full resident address ce applicant mber 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)
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