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t >>t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township o �`
Year
%" � FOR DEDUCTION FROM ASSESSED VALUATION
"4„ •- 1, State Form 43709(R14/1-20) g 6 Ale8k57` aD�1
• •• Prescribed by Department of Local Government Finance
File
INSTRUCTIONS: To be filedin 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. JV 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 Jariiiaiy 5 of the calendar year in which the p'ioperty taxes a're first due and payable. , • ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions
Taxing`Clistric Key number/legal description Record number Page numbe
il1)cdts(l� o?(o-/ — O7. 310)- coy - 1(,S=Da Z4oZI L
Assessed value of real property as of Mortgage I 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. application legal or 'table owner?
Ii /(063,33i) Yes ❑No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: a property in question:Annually Assessed
Real Property ❑Annually Assessed
"Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sell ^ ei, teft, iy,/,_j
t4� �e. P (—ll
Address of mortgagee or coot tier(number and street, - ,state,and ZIP code) • ' ._
Name of assignee or other owner or,holder of mortgage ' ' ' '
Address of assignee(number and street,city,state,and ZIP code) -
Does applicant own pro rty in any ' If yes,w t ounty? What Taxing District? ' - Has this deductio bee requested If yes,state amount of deduction'
other county on property for
in Indiana? es ❑Notjrt .— current year? es ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or nt ct indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county'-ecorder's office)that s the basis for the.deduction.
. `COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature7 of Cour(�ty/A�u/diito�r(�/fir{A/ ��/�J� y�/J///�/ �.�j/' _ County J,//////�////}/}/}//���']aj7 C t' /) Date(mon h l ,• r�
t. 4 2_/
I/We certify under the penalty of perjury that the abov d foregoing information is true and correct an. ;.;ri- r ITIC t Is a resident of Indiana and
owner/contract buyer of the aforementioned ope on date application is filed. 01
`/ Signature(owners f I me) Dat (rrepntO,year)
/yam \IVel ) 66f1 `v`
Full resident address of applicant(nu and street,city,state,and ZIP c e)
33 0 . / 9- 1-1-7&70 ,
A. ..
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 onth, .- ar
Address of authorized person (number and street,city,state,and ZIP code)
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