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HomeMy WebLinkAboutMortgage_Granderson cif n•Tp STATEMENT OF MORTGAGE OR CONTRACT I D er: --'�= FOR DEDUCTION FROM ASSESSED VALUATI Coylnty Township Year : � l .^ i'' '> State Form 43709(R14/1-20) .� az,i —: ,~` - (92 k Zio?AD '�``%%' Prescribed by Department of Local Government Finance ,e,e Tov INSTRUCTIONS: To be filed in person or by mail. DEC 3 0 2020 File Mark F• ed with: Filing Date: Form must be completed and dated in the calendar year for which the d potion is sou . A County Auditor Must be filed or postmarked with the County Auditor or County Record here the property is located on or before January 5 of the calendar year in which Applicant(owner or contract buyer-see rest't ns on reverse side) ,J T- �g District Key number/legadescription Record number Page number II„, Aeo - ad -lSE -Joo - oor , c.?.3 - oat" 70a1.o Y 7 g As essed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appl cant a sole assessment date,current year assessment date,current year date of application legal or eduit le owner? 3S© Doc, 1 es ❑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: Is 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) 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 y If yes,what county? That Taxing District? Has this deductio 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 o tract 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 )th t is the basis for the deduction. 'COUNTY AUDITOR Deduction approved in the amount of: 20 20 20 20 20 20 20 Signature f County Auditor < ,,� County Date(month,day,year) I/We certify under the penalty of perjury that the abov nd foregoing information is true and correct and that the applicant is a resident of Indiana and owner/contract buyer of the aforementioned property n date application is filed. vS atu;e(oyv�er'S (name Date(month,day,year) /Fullll resident address of applicant(number and street,city,state,and ZIP code) x /2-680 5. S c/4 nir, HaaAvtAlt4, I N zi'7639 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 penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.