HomeMy WebLinkAboutMortgage_Bolden (5) �.Mr-T--k, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.1 - FOR DEDUCTION FROM ASSESSED VALUATION
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\4., x- . State Form 43709(R14/1-20) Gson 028 2020
°4 7'`e." Prescribed by Department of Local Government Finance
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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. ® County Auditor
C 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 revers side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Bolden, DeeLaney L/Chris A/Kathy L Robinson
Taxing District Key number/legal description Record number Page number
028 26-12-07-102-001.145-028 Zn 0 2 2-q CI—
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Cone/ tedness un ' s of Is the applicant the sole
assessment date,current year assessment date,current year date of lica legal or equitable owner?
IZI Yes ❑No
If no,what is his/her exact share of interest? If owned with so one other t an If. ,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
A Pi a rop-rt ■Annually Assessed
1`0'o-a Home(IC 6-1.1-7)
Name of mortgagee or contract s r e , I
ks)..k.
con i.
Address of mortgagee or contract seller(number and street,city,state,and ZIP/o
JAN 07 2021
Name of assignee or other owner or holder of mortgage
•7 r./ . / •.'-'-'
Address of assignee(number and street,city,state,and ZIP code) GIBSON L Qv:n 1.`i—A ,.:;TOR
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? III 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 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 Ili a 20 20 t :atemo/th1
20
Signatur i o 1-.it r County y erarl ^
31
I/W; rtify under the penal of perjury that the above and foregoing information is true nd correct and that the applicant a resi nt of Indiana and
owner/contract buy o forementioned property on date application is filed.
Si t e owner's full n me) Date a
p� laney 1. ����. ` � 2
Ful resi a address of appli t(number and street,city,state,and ZIP code)
•
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)