HomeMy WebLinkAboutMortgage_Miller (39) MN, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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L i State Form 43709(R14/1-20�\y-ieie4Prescribed by Department of Local Government Finance
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INSTRUCTIONS: To be filed in person or by mail.
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Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. r
C tyfAuditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property it)
located on or before January 5 of the calendar year in which the property taxes are first due and payable. C C 2 County Recorder
See reverse side for additional instruction •nd qualifications. n,
Appli ant(o er contr ct buyer-s-e re: ons on.reverse side) GIGS /9[P/
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Taxi g istrici / ,nu t�/legal description r Record number `rib.=i .sr el"
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness un aid as of Is the ap li Pt the sole
assessment date,current year assessment date,current year date of application legal or table owner?
Yes ❑No
If no,what is his/her exact share of interest? If owned with someone other than pouse,indicate with whom
If name on record is different than that of applicant,indicate below: property in question:Annually Assessed
Is property
Property ❑Annually Assessed
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Name of mortgagee or contract seller
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Address of mortgagee or contract se er(number and street,city,state,and ZIP code)
Name of assignee or other., holder of ortgage /�'/Qf/J ) 7'./
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Address of assignee=n. eet, ty,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested I If yes,state amount of deduction '
other county on property-for__ „__- I—I m,
in Indiana? ❑Yes ❑No current ye --
A person is not entitled to this deduction unless the person has a balance on the person's mortgac _/��7 �O _, / (6,
recorder's office(including any home equity line of credit that is recorded in the county recorder's f (�""
'COUNTY AUDITOR Drawer NO
Deduction approved in the amount of:
20 20 20 20 20 Card NO.
Signature C tyAudit2r -.. Z 'County
I/We certi under t e penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner ntract buyer of the aforementioned property on date application is filed.
igna a(offers full name ,,,..er,‘......„, Date(month,day,year)
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e ident address of applicant number and street,city,state,and ZIP code)
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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)
The nenalties for neriunr ran include imnrisnnment un to two and a half years and a tine not to exceed S'10.000.