HomeMy WebLinkAboutMortgage_Roethemeier .�E�'•]s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�4 Count Township Year
-`%`=�s FOR DEDUCTION FROM ASSESSED.VALUATION
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, wig State Form 43709(R14/1-20)
„e Prescribed by Department of Local-dovernment'Finance nill��
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'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. DEC 3 1 `O%I 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 Jariury 5 a of the defend ye in which t e p' e y t es are first due and paya Ile.' ❑ County Recorder
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See reverse side for additional instructions and qualifications. � G GigSONCO{j Tmw./
Applic nt(o n ror contract buyer-s strictions on reverse side) •
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T i g Dp tncf ey number/legal descri i Record number Page number
Lis o.t -l3 15: a -0 a o.09/ o?6a.a Assessed value of real property as of . .Mortgage/Contract indebtedness unpaid as of Mortgage/Contractindebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current.year date of applicatio legal or equitable owner?
�Q. : . ❑Yds ❑No
If no,what is his/her exact share of interest? If owned with someone of er than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: I Ilsstt e property in question:Annually Assessed
`K I Real Property ❑.Annually Assessed
'Mobile Home(IC 6-1.1-7)
Nam o�mortgagee or c trod s e ) JJ� A/\)
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Address of mortgagee or ontract seuei(number and street,city,state,and ZIP code)
(35\U-1*- '
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
J-/3- /5 300-00A606 -006 • 44 l3- a7,2-4a0-006.0pp-c0
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? El 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 . 20 20 2p
Signature- ntyAu.litor - - Drawer NO...C°0 , , •Date(month;'day;year) ,
I/We certify under the penalty of per ury th; a l X c I that the applicant is a resident of Indiana and
owner/contract b yer of the aforementione Card NO. lJ
Sig abure(owneifu ame)0 Date(month,day,year)
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Full resident addre.s of applicant(number and street,city,state,and ZIP code)
X.
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.