HomeMy WebLinkAboutMortgage_Purkiser (2) ,.ER,� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS — unty P
Townshi Year
y` FOR DEDUCTION FROM ASSESSED VALUATION
• ._ )1 g State Form 43709(R14/1-20) 29
'�t.-' --, Prescribed by Department of Local Government Finance 5�76a,Lion �/
,eie
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. til- ounty Auditor
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 reverse side for additional instructions and qualifications.
Applicant( wner or contract bu -see restrictions on reverse side)
Taxi D' trict ey number/legal description Record number Page um
2t —2D^ DLO - /0D —DOD — 8-0 -bpi0749Z/ 0
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applican a sole
assessment date,current year assessment date,current year date of application legal or equ' le owner?
\0351356. — Yes El 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: Is the erty in question:Annually Assessed
eal Property ❑A .. '.tl
it7.ed
Isi Mo ICI-.Ho 1 6-1.1-7)
Name ofAiortgagee or contract seller ® t ,
(/G'/kA,1�./�.��C Quit( e 1jLt)
V 11.- •.
Address of mortgagee or contract se number and street,cit ate,and ZIP code
0 411 202"
Name of assignee or other owner or holder of mortgage
Address of assignee(number and scree city,state,and ZIP cotihstitdPUD,S
,,140000
Does applicant own property in a y If yes,what county? VtAriaSer 4/yes,state amount of deduction
other county
in Indiana? ❑Yes No
A person is not entitled to this deduction unless the pets /p� //��� ness that is recorded in the county
recorder's office(including any home equity line of credi "V "'i for the deduction.
Deduction approved in the amount of: /-deli
20 20 20 20 20 20 20
Signatur of County Auditor County Date(mon h,day,y ar)
/ I
I/We certify under the penalty of perjury t at the above and going information is true and correct and that the applican is a res dent of Indiana and
owner/contract buyer of the aforementioned pro erty on d to pplication is filed.
K./ Signature(owner' cf!' e) Date(no ,daly,ypa /
4)
Full resident�aaddddrreeJss of applicant(n/u�mber and street,city,sI24u /zr
and ZIP code) ,4/��/ �f
Person 5uthoAzed by duly 1/ 6 of Attot<ney or by IC 6 jr��J 1 /((o< 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.