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HomeMy WebLinkAboutMortgage_Armstrong (2) 1,--e,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS J. my Township Year v'r - +,,\,a FOR DEDUCTION FROM ASSESSED VALUATION , State Form 43709(R14/1-20) n /1 M'� Prescribed by Department of Local Government Finance 61— © �G ,(�(J rme 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. 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. Appf:,,... (owner or contract buyer-see restrictions on reverse si e) - f ams r 7z /ynsM cnt y_. Taxin. rct Key n ber/III description Record number Page number 1 f '6-ll-/2- 203-Qo3-Za.2--oaf 6022— 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 30, Dcz) legal or eeqquu''table owner? 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: Ins the property in question:Annually Assessed IXReal Property ElAnnually Assessed . 777��� Mobile -a• - (IC 6-1.1-7) Name of agee or contract seller 1, - -<S,,,..- X Address 2 mortgagee or contract seller(number and street,city,state,and ZIP code) "S-‘#),+ risl Name of assignee or other owner or holder of mortg 1- f , * NI Address of assignee(number and stree ty, te,a ZI Lode) - yP Does applicant own pr i n ,w county? What Taxing District? Has this deduction been requested If yes,state am 00ilrction other county on property for _G G— in Indiana? N-S ['YesEl current year? Yes No _C1A pers.t"'i o` QZ to 's eduction unless the person has a balance on the person's mortgage or contract indebtedness that iseporded in the county A�r ,.d:r, Is,a nc ,.'ng any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction. 'COUNTY AUDITOR ril_duc!tin a..roved in the amount of: 20 20 20 20 20 20 20 Signat`e f ountyAuditorl /) Count �`M Date(mont ,day year) 1/W certify under'tat penalty of p ' that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and Y o er/contract buyer of the afore a toned property on date application is filed. Le Signature(owner's full name) Date( onth, year) A ^ y....... 74 N2-1 Full resident ad ss of applicant(nwlber an st ee,ci ,sae,and ZIP de)� I ,5'f-lC , 3C& 4/7676 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) ter,______,a:__1•_-__-:.._.__�:.-_I..�l..:... .......{....{..{..........J..L...li..........,..,4..i:........{{..e.v.......r Q'�A AAA