HomeMy WebLinkAboutMortgage_Herman p., , STATEMENTOFMORTGAGEORCONTRACTINDE !NESS Count Townshi Year
FORDEDUCTIONFROASSESSEDVALUATION,..„
�f' ��� State Form 43709(R14/1-20)
Prescribed by Department of Local Government Finance
l9�( IN)
File Mark
INSTRUCTIONS: To be filed in person or by mail. BAN -7.8 Form filed with:
Filing Date: Form must be completed and dated in the calendar year for whl lie deduction is ot�e, ounty Auditor
Must be filed or postmarked with the County Auditor or CounttIl r of t e county where the property is
located on or before January 5 of the calendar year in which the xeVryy,due and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
OVNTYA(I�f�o
Ap . a owner or contract buy/ s r frictionss�n rever si
istric Key n mber/legal description Record number Page er
Z- ,0%&--dV- .1�-6a7 o? a
Assessed value of real prope y as of Mortgage/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 of ant.iejation legal or equitable owner?
❑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: Is the operty in question:Annually Assessed
eal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller r ( _
il
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner o mortgg - /J� / / /
•*°•• 0, 4
0 d icf-/-9e__.
Address of assignee(number an stree�,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been 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 contract 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)that is the basis for the deduction.
COUNTY AUDITOR -
Deduction approved in the amount of:
20 20 20 20 1 a 6 _
Drawer NO... ...
Signal e ofC un� ditor a L�,,� County ' 7 �'
I/ e certify under the penalty perjury that the above n� d foregoing information is t Card I\O. ........U LfZ I
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's` full name)
/YI
Full resident address of applicant(number and street,city,state,and ZIP code)
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Person authorized by duly executed Power of Attor a by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
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