HomeMy WebLinkAboutMortgage_Malone 0E�'"�eq, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS �1 f
. -'-hi Year
a'�" 1. FOR DEDUCTION FROM ASSESSED VALUATION
`; `' State Form 43709(R14/1-20) \ S� 00 vl ,/
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!,"ti' Prescribed by Department of Local
sought. yrlrypt! ,, Va County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county e, r
located on or before January 5 of the calendar year in which the property taxes are first 'e an a Y AU ti flu:.unty Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Taxing trict Key number/legal description Record number Page number
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Asse ed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the a lic the sole
ass sment date,current year assessment date,current year date of application / �f legal ore u'able owner?
t 69 ', 0 0 0 es ❑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: Is the property in question:Annually Assessed
teal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller E: r�C f _ —_
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Address of mortgagee or contract seller(number and street,city,state,and ZIP code) — -- ___'
Name of assignee or other owner or holder of mortgage
Drall; i' NO..
Address of assignee(number and street,city,state,and ZIP code) ••..•...2c7 -0
Does applicant own propeity in any If yes,what county? What Taxing District? Has Card N 2 P-- •••
other county on p 1 O. ., .
in Indiana? ❑Yes ®No curr
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A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract Inoeuu u, Ity
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 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjury th the ove and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
` - Signature(owner' full name) Date(month,day,year)
II esident 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.