HomeMy WebLinkAboutMortgage_Riley (14) #EP STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS - County Township Year
a
'._' FOR DEDUCTION FROM ASSESSED VALUATION
? �� State Form 43709(R14/1-20) Gson 022 2021
�eie'~" Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. Form filed with:
Filing Date: Fonn must be completed and dated in the calendar year for which the deduction is sought. Z County Auditor
Must be filed or postmarked with the County Auditor or County
-
Applicant(owner or contract buyer-see restrictions on reverse side) `
Riley, Tony E
Taxing District Key number/legal description Record number Page number
022 26-18-07-101-000.346-022 2020 4832
Elssessecumne_Of1PaLnrnnortv�e..,f l se—.----- -ntract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
ate,current year date of application legal or equitable owner?
50,000 LlYes ❑No
1.1
If owned with someone other than spouse,indicate with whom
\(Le^ v: Is the property in question:Annually Assessed
O a "'QQQ Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
'Q-N\e df)
4�r ✓4�27 state,and ZIP cod"e Olio 4°1
4'co Q
2...sc.\Do e.....- , .
What Taxing District? Has this deduction been requested If yes,state amount of deduction
• on property for
//��' current year? la Yes ❑No
0—2 6- ,dV ,has a balance on the person's mortgage or contract indebtedness that is recorded in the county
tat 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 Coun dilpr f� County Date(month,day,year)
W Gson 1/29/2021
1/We certify under the penalty of perjury th t th ve and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforem • ed perty on date application is filed.
Signatu (owner's full name) Date(month,day,year)
�J/mJnC 1/29/2021
Fuff re i�d2 add of a number and street, i ate,and ZIP code)
105 N S tt, O'ville, IN 47665
Person autho' ed by duly executed Power ofAtt y 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)
rh ne_n^Itiec fnr neriunr ran inrlude imnricnnmPnt un in twn and a half uuarc and a fins nnf to arreed.91n nnn