HomeMy WebLinkAboutMortgage_Davis (33) �ErF-�,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ounty Township Year
7. � �
' \a FOR DEDUCTION FROM ASSESSED VALUATION
Si ! State Form 43709(R14/1-20) h(RY1 � 'A 0, r �.i/
�. ,eie=J' Prescribed by Department of Local Government Finance vUtJur 14
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File :
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. 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.
Appli ant(owner r cpntract buyer-se restnc ns on reverse side)
r rr'ank tle-rIC,4 U4ViS
Taxing District Key number/legal description Record number Pate_number
►'YIc5htaonGAr _ 2_�-17- 27. 2DO— a , CD3- Del 021 i-1
Assessed vale real propels of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the soli
assessment d to current yea assessment date,current year date of application legal or eguitab wner?
yq /iatg DODP4s E 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 pr in question:Annually Assessed
eal Property ❑Annually Assessed
. &dt
Mobil Home(IC 6-1.1-7)
Name
of mortgagee or contract s Iler /�
Cc.rl r(nu b erQ./1As of mortgagee or contract seller(number and street,city,state,and ZIP code)
N\0.)
Name of assignee or other owner or holder 1 1���
Address of assignee(number and street,ci, I C J' .kr QQ'
� 1P V
Does applicant own property in any If ye �1LZ ion been requested If yes,state rra4fordeductIon
other county
in Indiana? ❑Yes IIINo � /� III Yes ❑No AGO
A person is not entitled to this deductic I t J -- contract indebtednes,j �recorded in the county
recorder's office(including any home e )that is the basis for rife deduction.
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signatur f County Auditor /�, // • County /� Date(month,day,year)
/�r 41 vt/Q- s f,S[7YC_ I/2.Co/2 0 Zi
I/ rti under the penalty of perjury that the above and for i information is true and correct and that the applicant is a resident of Indiana and
fY
owner/contract buyer of the of remention property on date a i ation is filed.
Signatur o ner's full am x
�,day,J year)^^�1
/ p�C9/o�C/o�
Full r n ess of a lic nt(number an street,city,state,and ZIP code) Date(mo7th/
P rson authorized by duly executed Pow 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. _