HomeMy WebLinkAboutMortgage_Perry (13) %°`'"rea� STATEMENT OF MORTGAGE OR CONTRACT INDEETEDNES TjyF nship Year
4,k .`_ O. FOR DEDUCTION FROM ASSESSED VALUATION - c I�
5\ z /1,h State Form 43709(R14/1-20) v J'�` t {. ��2I
iDepartment 'FEB 2-4 2 21
as Prescribedby of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
�orm filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is�Q 0 c O1 IN 1l f',UDITO County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the coun7 w er�fl3e p7d 3j�rty!s
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.
Appli t(owner or ontrg buy se= strictions on reverse si e)
Ta istrict v' number/legal description _� Record nu r Pa a number
of & - fc —b7 3Zq -. 001. '/<4_ O� 8 2(0 ��
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,or qu'able owner?
8 Li d 0 O �es ❑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: l�a thhe�e p'roperty in question:Annually Assessed
I�Real Property ❑Annually Assessed ,
- — - — , ne',tao.u.,.a4(IC 6-1.1-7)
Name of mortgagee or contract seller ,
06WAddress of mortgagee or contract seller(number and street city,state,and ZIP code) Drati��er N®
Name of assignee or other owner or holder of mortgage 9?-8-
•
Address of city,assignee(number and street, state,andZIPcode) Card NO.
Does applicant own property in a If yes,what county? What Taxing District? '_____ ....duction
other county on property for
in Indiana? ❑Yes No !current year? Ei Yes ❑No
• A person is not entitled to this deduction unless the person has a balance on the person's mortgage or••antra t indebtedness that is recorded in the county
recorder's office(iricludiing 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 Cont tor w . County Date(month;day,year) .
I 1 We certify under the penalty of perjury that the ab7<te----
regoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract: yer of the aforementioned property on date application is filed.
Signs re(o ner'sname) Date(month,day,year)
I
Full ident address of appli nt 4 ber and stree, ity,state,and ZIP code)
c
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)