HomeMy WebLinkAboutMortgage_Dyer (6) .ME aArf4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTED_INIF S._._ G t Township
/. ,..,. FOR DEDUCTION FROM ASSESSED VALUATION k y T Year
" ' '�p State Form 43709(R14/1-20) ;`,4 ) A,. ,' 02fsk9
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•y Prescribed by Department of Local Government Finance �-/ 1
N 0 U 2 C+ 02020 File Mark
For sled 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 t is
located on or before January 5 of the calendar year in which the property taxes, i County Recorder
vf ���� AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-sec-estrictions n reverse side)
Taxi istrigt Key number/legal description Record number Page number
✓14,YLe., iv eV CP rIi -13 - .iaq - oa3, 556, S -o x- w 25R0 794
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applic t the sole
assessment date,current year assessment date,current year date of application Q C/ legal or q able owner?
� / T9 7 Yes El No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: IsI�t property in question:Annually Assessed
E Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller '
Address of mortgagee or contract seller(number and street,city,state,and ZIP e)
peA n
Name of assignee or other owner or holder of mortgage Di al �1 �i°,..
Address of assignee(number and street,city,state,and ZIP code) Card
No
• ''''''Q)-9
Does applicant own property in any If yes,what county? What Taxing District? Has this deducti b n req...__. •••.
other county on property for
in Indiana? ❑Yes ,No current year? Yes ❑No
A person is not entitled t this deduction unless the person has a balance on the person's mortgage or ontr ct indebtedness that is recorded in the county
recorder's office(including any home equity fine 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 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I% iderthep enalty of perjury that the bov nd foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property n date application is filed.
r
\/` Signature(owner's full name Date(month,day,year)
ul reside t address of applicant(numb and st , ity,state,and ZIP code)
609 wok_Pm i a ,'/rD- y) IA '`�7�n �o
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.