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HomeMy WebLinkAboutMortgage_Halbig (4) 0,ER,-r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year a "-\, * __,. FOR DEDUCTION FROM ASSESSED VALUATION xl r i% l72 �-..L� State Form 43709(R14/1-20) "' -,,i, Prescribed by Department of Local Government Finance ��� ©� �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. County 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 dditional instructions and qualifications. Appli`nt(oi o buyer) ri ions o rsefide) 0 / ' 4 Air !?, f 7L Taxing District Key tuber/ al descripti Record number Page numb r -�� -��- � in:;;? K2,\ St Assessed value of real property as o 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 o pp at legal or equitable owner?j III Yes ❑No If no,what is his/her exact share of interest? If owned with someone other than spouse,indi e with whom If name on record is different than that of applicant,indicate below: Is the pro in a esin:An• ally Assessed c 2,,07/ Real Prope"y IA An dal essed \LX Name of mortgagee or contract seller /� 0,9 Address of mortgagee or contract seller(number and street,ay,state,an ZIP code) 4'Q l Name of assignee or other owner or holder of mortgage SO�'C�vAl7: `9(/Q` / Address of assignee(number and stVI' land�I',de) /j/ •Y / fj � OE fff////J Does applicant own property in any f yes�at county? What Taxing District? Has this deduction been requested If yes,state amount of deduction other county on property for in Indiana? ❑Yes III 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 2 20 20 20 20 20 igna re of C unty ditor . County Date(month,day,year) 11 / I/W certify under he penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and owner/co ract buyer of the aforemention d perty on to application is filed. . Signature( is full e) • Date(month,day,year) Full r 'd nt add s of pplicant(nu era s et,ci to d ZIP de) A/,12e71 at.)./.a_ 7, , 6 J9 son authorized by duly executed 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) Tho nonallice fnr narinni ran innlnr/a imnricnnmont,,n in hnrn and a half vaarc nod a find not in ovraarf St1n nnn