HomeMy WebLinkAboutMortgage_Lamey (19) .,f=��,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS �7 Township
a�i�, ram=`�. ,,. _ Year
= FOR DEDUCTION FROM ASSESSED VALUATION
1 State Form 43709(R14/1-20) -
ro. Prescribed by Department of Local Government Finance y
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INSTRUCTIONS: To be filed in person or by mail. C 2 File
2020 Form f 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 countRigk�l!e t
located on or before January 5 of the calendar year in which the property taxes are first dYe fd(Gvey County Recorder
See reverse side for additional instructions and qualifications. LINTY 4 LIDl
Applicant(.w r contract buyer--- -strictiens..vreve a tide) T O�
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Taxing District , Key number/legal description Record number Pa a number
4-as-/f -cod .39 o-oaf ,,/D,o z a �
Assessed value of real property-as of Mortgage/Contrac indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year datee:o;fip ication legal or equitable owner?
00 ❑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: Is th property in question:Annually Assessed
Real Property LI Annually Assessed
/� /�///J� ic4.,
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /�� `-�
Address of mortgagee or contract'sel/ller!(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)
•
y DIE' it
Doesed co applicantu own property in any If yes,what county? What Taxing Di. LAP'ef DA
oth iunt of deduction
YYin Indiana?nty ❑ CI 5Yes No , I l
A person is not entitled to this deduction unless the person has a balance on l ded in the county
recorder's office(including any home equity fine of credit that is recorded in t I/
'COUN' • X/A ill �•-60).D
Deduction approved in the amount of: ' (/4
20 20 20 20 20 20 20
Signature of u Auditgr County Date(month,day,year)
I/We certify under the penalerjuryj�flf3f"ffie above 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(owne'-fm)" me) Date(month,day,year)
Full reside •ddress of app sca
njt(number nd sheet, ty,st e,and Z c )
L7OO oC 4
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.
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