HomeMy WebLinkAboutMortgage_Lustfeldt 4.�*•t„ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
ti.:--. State Form 43709(R14/1-20) Gson 024 2020
° '`` z Prescribed by Department of Local Government Finance
�016
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. 121 County Auditor
Must be filed or postmarked with the County Auditor or
Applicant(owner or contract buyer-see restrictions on reverse side)
Lustfeldt, Austin/Amanda
Taxing District Key number/legal description Rgcor be Page tuber
027 26-12-16-101-001.522-027 ('/! 5 (/�
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mort gge/Contract indebtedness unpaid as of Is the applicant the so e '
assessment date,current year assessment date,current year dot [a[zoli io r� legal or equitable owner?
VV4 )) v� Yes ❑No
If no,what is his/her exact share of interest? If owned with meone dther than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
VI Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mot, on et el r y
tI I - 1 ` •
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) L
Name of assignee or other owner or holder of mortgage DEL Y`6 ZUZU
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? ®gitS ,FJlctiort.bet=nl�eg4l tal I JYIy'es,state amount of deduction
other county on property for
in Indiana? ['YesElNo current year? ®Yes ❑No
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 III
20 20 20 20 20
Signature of County Au.
•' M 44 n County 1 Date mo th da a
/ l l
I/We certify under the penalty of perjury t e above and foregoing information is a and correct and that the applicant a resi nt of Indiana and'
owner/contract buyer of the aforementioned_xoperty-ondateapplication is filed.
Signature(o \Hers full name) /' Date�rrya�th, a/�e f
Full resident address of applicant r mb and street, ,state,and ZIP code) •
2144 E SR 64 p €TD/t l"\
Person authorized by dul'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.