HomeMy WebLinkAboutMortgage_Ballard Jr .Mr���, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�`� `� FOR DEDUCTION FROM ASSESSED VALUATION �n
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"\:7 i' State Form 43709(R14/1-20)
--4. Prescribed by Department of Local
/' t
r1 Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sotpl.V `� Count Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where th®�,Qirf�is y
located on or before January 5 of the calendar year in which the property taxes are fir t due nd payable. ` ❑ County Recorder
See reverse side for additional instructions and qualifications. GIBSON C:OUI�►T1,
Applicant(o rr or cconnraLLct buynner-see res chops on reverse side) AUDITOR
Taxiryg ii nct' Key number/legal des on Record number Page n bet
01Z0/ ,! d0-06107. 1,5D—DQ?S 0?4
Assess value property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the a lic t the sole
assessment date,current year assessment date,current year date of application p legal or eq 'able owner?
DCCOYes ❑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 e property in question:Annually Assessed
Real Property Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
atti
4 /St
Address of mortgagee or contract seller(num er d street,city,st e,and ZIP code)
Name of assignee o eore1 holder of mo ge O
Address of assignee(l er and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested I If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ❑No current year?
A person is not entitled to this deduction unless the person has a balance on the person's mortgage of U o,_0 -- Sv / Y
recorder's office(including any home equity line of credit that is recorded in the county recorder's offic
'COUNTY AUDITOR
Deduction approved in the amount of: D I ati��l T O •
20 20 20 20 20_ Card NO.
Signature of Audit4 71.1
/� "' County
I/We certify under th penalty of perjury tha-t the above 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.
S' ature(ow er's full name) Date(month,day,year)
Full eside t address of applicant(number and street,city,s t and P 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.