HomeMy WebLinkAboutMortgage_Hunt (12) E ivmay„ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS -19v Is Year
7 ,.__ �{ ,; FOR DEDUCTION FROM ASSESSED VALUATION14-1L �:
1 '7? "i: State Form 43709(R14/1-20) '0 2
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"` �' Prescribed by Department of Local Government Finance
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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. Co my Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the countywhere i
located on or before January 5 of the calendar year in which the property taxes are firstAU"due ' .O N Y
/� Ttorty Recorder
See reverse side for additional instructions and qualifications.
Applican (owner or contract buyer-see restrictions on reverse side) ` ��
in, /�" A
Toxin strict, Key number/legal description Record number Page number
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Assessed value of real property 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 application legal equitable owner?
3 3 O 7 So es ❑No
If no,what is his I 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 property in question:Annually Assessed
"eal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller n 3
Err e_ a ()-D / - `7 -
Address of mortgagee or contract seller(number and street,city,state,anc
Drawer NO
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) Card N O•
Does applicant own property in any If yes,what county? VVhat Taxing District? Has this deduction been equested If yes,state amount of deduction
other county on propertyfor
in Indiana? ❑Yes ❑No currnt yer? es ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or ontract 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 20 20 20
Signature of,Countyyy Auditor �, / ��_ �� County Date(month,day,year)
Lr, [N�2�Z�C/r'�J /,'
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II We certify under the penalty of perjury that the ab�tre and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned prop rty on date application is filed.
Signature(owner's full ) Date(month,day,year)
iCull resident address of applicant(number and street,city,state,and ZIP code) c
3 I I 104- J).J (j7470
Person 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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.