HomeMy WebLinkAboutMortgage_Johnson (31) � P9, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship�" %` `'= FOR DEDUCTION FROM ASSESSED VALUATION Year
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State Form 43709(R14/1-20) p
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Prescribed by Department of Local Goverriment Firiance
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. Nr 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. . •
Appli n ( caner or contr ct buye( see res 'cti nsdrev ' e)
Ta ' i is Key numb r/legal descri lion Record number P umber
6 - a 3 4 Via- lea. a bac( ao-Lz
Ass ed value of real property as of • Mortgage/Contract indebtedness unpaid as of Mortgage/Contract inde tedness unpaid as of Is the a li nt the sole
ass sment date,current year assessmentd�t�cySrenyye�rD date of application p legal or: noble owner?
VV'��11// �U Yes No
If no,what is his/her exact share of interest? If owned with someone other than spou " dicate with whom
If name on record is different than that of applicant,indicate below: Is /proof quest'f nnually Assessed
eal Pro KV, to 'nn ssessed
•j ooie ,mme(IC6-1.1-7)
Name of mortgagee or contract seller Dk-r+ '
C91112426717/45,
Address of mortgagee or contract seller(number and street,-city,state,and ZIP code) V' ��
Name of assignee or other owner or holder of mortgage fetS'Q�CQ . •
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Address of assignee(number and street,city,state,and ZIP code) I t QR
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested. If yes,state amount of deduction
other county on property for
in Indiana? DYes IIINo current year? ❑Yes' ❑No
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 r 20 .
Signature Auditor. • County . . • • . -Date(month;day year)
lie ./74,7/1)
I/We certify under he penalty of perjury VIM the 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(owner's full name) Date(month,day, ear)
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Full resident address of applicant(number a street,city,state,and ZIP code)
a&c 5- („) i o ., s� i 4`" Y 7G Y 8
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)
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