HomeMy WebLinkAboutMortgage_Dewig (10) ,0,,;17, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear
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�• FOR DEDUCTION FROM ASSESSED VALUATION
j't":3.2`:'i;.C�g State Form 43709(R14/1-20) Gson 009 2020
";eie'v' Prescribed by Department of Local Government Finance
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
Must be filed or postmarked with the County Auditor or
Dewig, Nicholas C
Taxing District Key number/legal description Record number Page number
009 26-19-31-301-000.072-009 2-/ 2,3/
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date o lice t P legal or equitable owner?
COjO— ®Yes ❑No
If no,what is his/her exact share of interest? If owned with so eone other tharrspouse,indicate with whom
•
If name on record is different than that of applicant,indicate belay per roperty in question:Annu. oAssessed ;•.
(�Er ,, 11G; 4 Lie I vL/�s l� it Property biI a(IC 6-1.1-7) ""
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Name of mortgagee or contract seN.... A
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Address of mortgagee or contract seller(number and street,city, •
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Name of assignee or other owner or holder of mortgage D -Ad
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Address of assignee(number and street,city,state,and ZIP coder L �� 004
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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 20 20 20 20
Signature of County Auditor County Date(month,day,year)
12/30/2020
I/We certify under the penalty of perjury that 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.
X\r Signature(owner's fi�Ilna�e) Date(month,day,year)
.
�V l/L/�� /v rJ( I�Mk 12/30/2020
Full resident address of applicant(number and street,city,state,and ZIP code)
219 N Main ST, Haub, IN 47639
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.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEB ES
Name of applicant Name of mortgagee or contr
Dewig, Nicholas C — bc151)'
Date filed(month,day,year) Amount of a ne s ply Taxi District
12/30/2020 � Q 0 U 009 *'" ,�( ,/4)'?'
Key number/legal description a.y" V\
26-19-31-301-000.072-009 / 904'c ��
Signature of County Auditor/County Recorder County pJ,oS1th,day,year)
Gson e's� 12/30/2020