HomeMy WebLinkAboutMortgage_Schafer (12) ,.T.r., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear
v.%4; FOR DEDUCTION FROM ASSESSED VALUATION
R ?_?azj+ State Form 43709(R14/1-20) SQ—Z9—
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• ' Prescribed by Department of Local Government Finance i; r. —/ay
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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. E(' �020 County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where t e p 6p rt r
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.
Applica t wnerorcontractbuyer-see restrictions on reverse side) GIDSON COUV I Y AUDITOR
Taxi District Key number/legal description Record number Page numben
a —� a (o - o5 - ,Ig- ,moo • oo 3101 - 6, a 7 Do Z 0/)
Assessed value of real prope y as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applica t the sole
assessment date,current year assessment date,current year date of application legal or eq 'able owner?
` O) Dn Yes ❑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: I the property in question:Annually Assessed
[ Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or c n act seller
SC,PAF1 ; e gLs 14,
Address of mortgagee or contract seller(number and street,city,state,and ZIP cot /,15-1 t
147
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deducti n ben requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ❑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 nt 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 offic tha 's the basis for the deduction.
'COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signatur of ty Audito s / County Date(month,day,year)
I/We certify under the penalty of perjury that the ab a 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.
k SI'ner's full me) Date(month,day,year)
✓` l�Z�/zoo
ad ess of/aeplicant mb and stye t,city, fate,and ZIP code)
/,7 I/vN[le P/Z //L t-vCc7T''ir 4' y7g.?�orized 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 foroeriury can include imprisonment up to two and a half years and a fine not to exceed S10.000.