HomeMy WebLinkAboutMortgage_Leary I .ME--,AArt,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
`_ " 1 FOR DEDUCTION FROM ASSESSED VALUATION 1
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1''.:^.Zt,'' State Form 43709(R14/1-20) �C�
'y`„.. Prescribed by Department of Local Government Finance j\-SO�eie
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.
i 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. County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner buyer-see restrictions on reverse side)
Taxing ' tri ,,��\\VV / er/legal description Record number Page number
�' Z6-12- 09 - 302 - 0 OE• t42•- 0 2 '?-- 7-o ?-ro 3R-\O
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of ppligatior� `^v - legal o uitable owner?
k. I �� Jv Yes III No
If no,what is his/her exact share of interest? If owned with s eone other t)an spouse,indicate with whom
If name on record is different than that of applicant,indicate below: c. _ L I,t operty in question:Annually Assessed
, I Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contr ct s er p DEC 4
2020
Address o g e or contract'sder(number and street city,state,and ZIP code)
Name of assigne or other owner or holder of mortgage .kiiiiLL( -
-nilSON COUNTY AUDITOR
Address of assignee(number and sire
Does applicant own property in any Has this deductio be requested If yes,state amount of deduction
other county on property for
in Indiana? Ill Yes ❑No D 1 alti,�'I N O••..••............. current year? Yes ❑No
A person is not entitled to this ded s mortgage or ont ct indebtedness that is recorded in the county
recorder's office(including any ho5.---q-10 !corder's office)that is the basis for the deduction.
Card NO. ... ..... R
Deduction approved in the amount of: •
20 20 20 20 20 20 20
Signature o=our Audittl ‘,T) Count Date(month day ear 1.\--7
I/We certify undeer`the penalty of perjury that the above and foregoing informati true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforemention rope on date application is filed.
Signature(own name) Date(month,day,year)
Full r i t address of applicant( umber.nd street,city,state,and ill;code) l ` '
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)