HomeMy WebLinkAboutMortgage_Hope (2) 17n,=��, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS �oant — nshi
':-�-•<� FOR DEDUCTION FROM ASSESSED VALUATION Y p Year
., ..1!: -A.,$t �l"\' i'�:z'/' State Form 43709(R14/1-20)
%� Prescribed by Department of Local Government Finance
,/ I County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where t p
located on or before January 5 of the calendar year in which the property taxes are firgrtig pde 11TY AUDIT County Recorder
See reverse side for additional instructions and qualifications.
Applicant(o er or contract buyer-see restricti ns on reverse side)
Taxing Distri Key n mb r/legal description Record number Page number
, •1-6 -O 5 - '- -) - /+z5 -00.3. o I to -0 / 7 )-, 58 7-
Assessed value of Veal 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?
E U 600 ❑Yes ❑No
If no,what is his/her exact share of interest? If owned with someone other thafi spouse,indicate with whom
If name on record is different than that of applicant,indicate below: s th property in question:Annually Assessed
[Real Property.❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
1 --PL J Cis I TJ
Name of assignee or other owner or holder of mortgage i/ i r1 tb y�,��Jy,4-�
Address of assignee(number and street,city,state,and ZIP code) )) v�
L.
Does applicant own propert i any . If yes,what county? What Taxing District? Has this c al/''58a( 7-r oU J -
other county on proper
in Indiana? ❑Yes No current ye
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 County Auditor County Date(month,day,year)
I/ e certify under the penalty of perjury that the bove 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.
Signature(ow full name) I Date(month,day,year)
Full resident address of applicant(number and street,city,state,and ZIP code)
X 3 £X J-b D 4._ jf``10 l-e. `�2
Person aut 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)
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