HomeMy WebLinkAboutMortgage_Smith III �a .N. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
- FOR DEDUCTION FROM ASSESSED VALUATION
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Wit%' ' State Form 43709(R12/6-14) I� 0 2o'2_
"o# Prescribed by Department of Local Government Finance DECEIVED A�
INSTRUCTIONS: 11�C `, C — NL V File Mark
To be filed in person or by mail. I 0 t t 1 1 (� ��20 Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. I❑`County Recorde
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(own.etior contract buyer-see rfistrictio pon ref rs s/ e)
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V.
1111
Taxing District Key umber/legal description Record number Page number
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Or7 (O � ,-3��®D-Xy.00D5�-0 ,i 20�0 . s 34-
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole
March 1,current year Mare current year date of a Iicatio-n—/�, legal or equ,table owner?
� l t~""O ❑ No
If no,what Is his/her exact share of interest? If owned with someone other than spouse,indicate with whom l6-/Yes
— - -If-name on record-is different than that ofappiicant,-indicate below:- - _Ls_ property In question:Annually Assessed
ea!Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7
Nampl mortgagee or contractseller
t'((1/1Cl/� i7'Vl'ef IC/1t'��Cl� t a
P...... F I a
, - ,Address of mortgagee or contract seller(number and street,city,state,and ZIP code) - S_ s
Name of assignee or other owner or holder of mortgage NU V 2 0 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 DistriPSON 14414A1 16i ' .-,-Ci%quested If yes,state amount of deduction
other county on property for'
in Indiana? ❑Yes 0 No current year? :.Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or •n.=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 20 20 20 20 20 20
Signature of Coun or County , Date(mo th,day, y ar) 117 '
NY1 C.
I/We certify un er the penalty of perj a the above and foregoing information i3S0
and correct and that the applicant i a resioent of Indiana and
owner-/contract buyer of the_aforementionedproperty on date application is filed. ,
Sign lure(owner's full me) Date(month,-da yeas -
Full resident address of applicant(number and stpt,city,state,and IP code)
1011 E 350 S l ri`vt� Ir Li 1 ( o 1
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.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBT_D IS Frs' ,
Name of ap 'cant Name of mortgagee or contract sell \ _ 1 3 �i
Sm 1�� CA eA-1 can�'
Date filed(month, ar) Amount ind tedness Taxin Distri A V ® 2020
11- �� . . � 0 -- - 2 '
Key number/le al caption
26-- \2 32 2'O 0-OO C6 --02 r-"
Signature of County Audi /Coun corder �__..)._.. County r1 GIBSOl PleelV�;id0y,1xe,at)i-)-LDR
L oCkc aea/`-�i e_ —tJ'1`/,1u_'�\YiOL) c) 0 l3 d-_ -wits vi l l-Q l 76 to