HomeMy WebLinkAboutMortgage_Deffendall ri- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS u'<:•' 1 County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
0'" `:: ,; State Form 43709(R14/1-20) t b501 r� f�(
;a,a�60 Prescribed by Department of Local Government Finance • v �)2I
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.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Auditor
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.
Appr ant(owner or ntra er-see restrictions on reverse side)
T;gxj.n.g Distric Key number/legal description Record number Page number
CCtp ICQ ap— I--)3 — 3OO—00a .0 3-7 —oa--7 ,'; I-73 3
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Modo ge/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of a plication legal or equitable owner?
1 aU � bOO 'es ❑No
If no,what is his/her exact share of interest? If owned with someone o/her than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is th property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgage or contract seller derPiz —Address of mortgagee or contract seller d street,city,state,and ZIP code) iti
Name of assignee or other owner or holder of mortgage
FB ®I
Address of assignee(number and street,city,state,and ZIP code) (U2/
Does applicant own property in any If yes,what county? What Taxing District? Has this deducti eeenf equue U
other county on property for q ount of deduction
in Indiana? ❑Yes No current year? Yes ❑No Y^1(./
O
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or c nt ct 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 t the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature o ty Aud orj074:441.<, Count
� � Y Date(month,day,year)
I/We c ify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforemen. ned property on date application is filed.
Sigi5a ur owner' me) _l2atP(month,day,yea
-asi7
II side add ss of app icanl( m r and street,city,state ZIP code)
I L-1 13 s v , r Eli c e,-f o n I rS I-I-Z (-0 7 0
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.