HomeMy WebLinkAboutMortgage_Bush (3) E-----, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS county Township Year
%' FOR DEDUCTION FROM ASSESSED VALUATION
" 1, State Form 43709(R14/1-20) ,�� (D 2-9- `� I
a _B-•e' Prescribed by Department of Local Government Finance J v C�
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. X 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 additional instructions and qualifications.
Applicant ,er or cant c buyer/restrictions reverse side
Tail)istri, A,-y ber/legal descri• -.n Record number Pa a number
Assessed value of rea pro,-rty as of Mortgage/Contract indebtedness unpaid as of Mortgqagee�/Contract indebtedness unpaid as of Is the applic t the sole
assessment date,current year assessment date,current year datey tion legal or eq table owner?
i p 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: I�s t property in question:Annually Assessed
Real Property ❑Annually Assessed
PILE
MobileHome(IC 6-1.1-7)Name of mortgagee or contract seller ���-2/
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) '
Name of assignee or other owner or holder of mortgage FE8
9 ?021
Address of assignee(number and street,city,state,and ZIP code) G/7� �,
SOON CO�t 4�� ,�
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction be requested If yes,stpa Ar ction
other county ❑ ❑ on property for it
in Indiana? Yes No current year? Yes ❑No OR
A person is not entitled to this deduction unless the person has a balance on the person's mortgage o 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
2
Signatur of Co ntyA tor County Date(month,day,year)
/ &O.1 V/1 J074.41,0
I/We ertify 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 th- - orementioned property on date application is filed.
Signature(owner's NI a .�/ Date(month,day,year)
Full resi a address of-•,plican numb' . . 'ree,o ) n.Z!Pcodet: �: "
Person authorized by duly - ut/'•ower 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.