HomeMy WebLinkAboutMortgage_Resenbeck (3) �.0.27%,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
\� FOR DEDUCTION FROM ASSESSED VALUATION
�.xJ.-..=1,- 1 State Form 43709(R14/1-20) O
Z Prescribed by Department of Local Government Finance
person n I , L`.10 Z` • File Mark
INSTRUCTIONS: To be filed in orbymail. ¶Q ' J.�
Form filed 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 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 s' a for additional instructions and qualifications.
Appli nt w er or contract buyer-see restrictions verse si e)
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ber/leg deriptRecord numbe Pa a number
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ice•, 7q - a . 7o� LUdvaIeaIprop '
erty as of Mortgage/C ntract indebtedness unpaid as of Mortgage/Contras 'ndebtedness unpaid as o Ii p Rcant the sole
assessment date,current year assessment date,current year date o�f�fpplicatio I quits..,-owner?
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// Y No
If no,what is his/her exact share of interest? If owned with someone : !other'than spouse,in icate with`44n- "
--—-If-name-on-record-is different than thatof-applicant,-indicate below: • Is - ' ,question:Annugit essed—-
Real pragoe Annually Msessed
00 Q6lobile Home(IC 6-1.1-7)
Name of mortgagee or contract Belle >/t
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Address of mortgagee or contract seller(number and street,cit. t ,and ZIP code) T
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Name of assignee or other owner or o of mortga / n kael//
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Address of assignee(number an st , ty,state,and ZI
Does applicant own property in any If yes,what county? What Taxing District? Has this deductio een 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 c nt t 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) hat is he basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
I
S natur of Co nt Auditor County Date(month,day,year)
I/W certify under e penalty of perjury th t� 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.
'Signat e wrier'` Date(month,day,year)
0111°
Rd!re_-addres_o ap.icant(number and street,city,state,and ZIP code)
?( 300 At mats i 8f. Ff- Bn nc4, MI 4-74443
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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REC IPT FOR FILING STATEMENT OF MORTGA E OR CONTRACT INDEBTEDNESS
N e o scant N f mortgagee or co t se
Da a ont,d y,yea) Amount o eb dness /�••i in i rict F E _
C /
Key er/le.-�•,es i lion JAN
- I —�.�— 07- JaZ 2020 4Bo3• L4_
2021
Si•.nature o ou }yA,.itor C unty Recor er , 'C my Date month,day,year)
�� GIBSORI COUNTY AUDITOR