HomeMy WebLinkAboutMortgage_Campbell (4) ,:o sgT6 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
��.:�a; County Township Year
�/ - FOR DEDUCTION FROM ASSESSED VALUATION `` ✓�
"\ fr..0 State Form 43709(R14/1-20) c ' Q I O� u
„a•• Prescribed by Department of Local Goverriment Finance L
Fi ark .
=. INSTRUCTIONS: 'To be filed'in person or by mail.
r ilk;ith:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. M? . _Inty Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the parfolyily a
located on or before January 5 of the calendar year in which the property taxes are first u and payable 0 20 El County Recorder
?,
See reverse side for additional instructions and qualificatio s. G/
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Applican�• er or contract buyer-see7ricevrsi e) CONT-. • •i Ku ber/legal escri on o�-� �� ���� Record n nbd'fR Page'number
If
A eased valu4AcyzeL
al property as of .• .Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the�ole
assessment date,current year assessment date,current year date of appli ation O� p legal or ep'uitable owner?
/p/?/�_ Yes ❑No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whomY
If name on record is different than that of applicant,indicate below: Is tthh property in question:Annually Assessed
yQ Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller nr ?,
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) - -
Name of assignee or other holder of ortgage • � /ev L���I .,4 n//��
a. .
. .
Address of assignee(number and -et,ci ,state,and ZIP code)
Does.applicant own property in any ' If yes,what county? What Taxing District? Has this deduction n 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 ont ct 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)tha is the'basis for the.deduction..
' 'COUNTY AUDITOR
Deduction approved in the amount of: '
20 ; 20 20 20 20 20 20
ignatu _f�urTty�uditor a /7�� County , { C) Datel( n(i,de year)
2...) ,
1/W certify under the penalty of perjury that the above and foregoing information is true n correct and that the applicant's a res ent of Indiana and
owner I contract buyer of the aforementioned prope on date application is filed.
Signature(owner's fu Date(month,day,year)
i
Full dent adds of plican mbe nd street ci state, IP e) n
Person authorized by duly e ed 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)