HomeMy WebLinkAboutMortgage_Mason (19) a ��,� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
%' ` FOR DEDUCTION FROM ASSESSED VALUATION County Township Year
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�,rfti�h State Form 43709(R14/1-20) J lJ
`.:. , Prescribed by Department of Local Government Finance
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INSTRUCTIONS: To be filed in person or by mail. File Mark
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 sii.-for additional ins uctions and qualifications.
Applicant(o Ter or contract buye - eerestricti so reverse side)
Taxi istric Key numb /legal description Reco d nu er Page n b
Assessed value of real rope as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract i d tedness unpaid as of I applicant the sole
assessment date,current year assessment date,current year date of application (/ I uitable owner?
(JX - ❑NO
If no,what is his/her exact share of interest? If owned with someone other tharespouse,indicate with whom' 4
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If name on record is different than that of applicant,indicate below: Is a property in question n}ifly Assess . ,'
Real , r•erty ❑Annt4SIIWA essed ,
049 Mobile odic 6-1.1-7)
Name of mortgagee or contract seller S'Q
P — el 4,
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) ,947= .
Az-
�/poName of assignee or otherr,�older of m aoge C-\le j �'�_70 c, c,, fr/-9& .
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Address of assignee(num:-r and t,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction bee requested If yes,state amount of deduction
other county on property' or
in Indiana? ❑Yes ❑No , current yea . es ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgageo _ ntract 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 I 20 I 20 I 20
Sig tune of ouA Audi �/ �� County
I/ e certify under the penalty of perjury that the above and foregoing information is a and
owner/contract buyer of the aforementioned property on date application is filed.
Signs re(owner's full namee)) Drawer NO�L t�Full resident address of plicant(num r and street,city,,state,and ZIP code) Card N O.
I gi-46 L. /a M. � ( �/i)-ice /vr?, �i(/ �71,2
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
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.