HomeMy WebLinkAboutMortgage_Igel ,<En..p STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
,� County ship Year
�r� �.�� FOR DEDUCTION FROM ASSESSED VALUATION
a„ j2thS1)/ lirikk—EicA;;:1 .:L j+ State Form 43709(R14/1-20) 2DW
- Prescribed by Department of Local Government Finance
INSTRUCTIONS: To be filed in person or by mail. File Mark
Form filed wi
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. ounty 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.
Appli (owner or co ct buyer-se restnch son reve side)
Taxing Dis rict Key numb r legal description Record number Page number
Alle trOL 2La W.D7 lei• ocoz -369y- eag' )‘04k e ST12 .
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 application legal or equitable owner?
/9 7 L o DO 2Tes ❑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 perty in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller .,_
�l T /— L . _L-c tt
Address of mortgagee or contract seller(number --v Io 0
Name of assignee or other owner or holder of me Drawer N O 1_ y,..:41
DVS, 4 �`Z�
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Address of assignee(number and street,city,st
Card NO. 5----T( ��->ol
Does applicant own property in any If yes,w1 deduction been requested If ya'1e e(it bf'deduction
other county I I un Niuperty for GOB
in Indiana? ❑Yes ❑No current year? ❑Yes ❑l Np, OA
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract 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 C nty Auditor /7 County Date(month,day,year)
....„,q2
I/W certify under the pen Ity of perjury that he above and foregoing information is true and correct and that the applicant is a resident of Indiana and t.
er/contract buy of a aforementioned property on date application is filed.
Signature(ow ull name) Date(month,day,y r)
Full resident address of applicant(numb r and street,city,scat d ZIP code) p
/A/9 (770G2,61
L/ 5 tj v 6`1 _
rr ,a, jr q-7G070
Person authorized by duly execu d 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.