HomeMy WebLinkAboutMortgage_Jines (5) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES
/ } • y +ship Year
FOR DEDUCTION FROM ASSESSED VALUATION
"' 3 ga s04 State Form 43709(R14/1-20) ti0E Pr.7\ ti
">F' Prescribed by Department of Local Government Finance
INSTRUCTIONS: To be filed in person or by mail. FEB 2 5 20 rile Mark
Form d with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sou t. County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county t r p- ,
located on or before January 5 of the calendar year in which the property taxes are fir. rtfgt <.4..Or Y AUDITOTe
County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contrac u r see estrictio s ev side)
a 1 6 f9/7 i-&0 .
Ta d:D'-tri t Key number gal d cription Record numbernumber
' # -�;�u 4-la 09-103-02 . / 607 aoao Page cam
Assessed value of real pr perty as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applican the sole
assessment date,current year assemnant date,current yew date of application legal o e. '-.le owner?
�4^ /0 CV ►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 I e-property inquestion:Annually Assessed
- -- _
eal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller n
(�f//L
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
-
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any- If yes,what county? What Taxing District? Has this dedu ' n en requested If yes,state amount of deduction
other counon proert in Indiana? ['Yes ❑No currrentyear?or Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or cont t 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
Si_q_cirf7ounty uditor �G/�., /- County Date(monthda yea o /
1,We certify 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 aforementioned property on date application is filed.
Sionat- --.aet;}'s full 4-'•e) . Date(month,day,year)
CI_ res..- Qr,•r-ss o •nt(n ber and street,city,state,and ZIP code) _,_-r 'L
A 0• ,\,un Moo E- �d(iou\ C Esi. a',Acckor1�-I`I (-161�
Person au ofiz�d by du ex cgted Powder 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.
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