HomeMy WebLinkAboutMortgage_Hinkel ,, r4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTE N Township Year
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��.r_2;R�� FOR DEDUCTION FROM ASSESSED VALUATION
l` �8iE State Form 43709(R14/1-20)
'''''� �,4 Prescribed by Department of Local Government Finance xi
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File Mark
INSTRUCTIONS: To be filed in person or by mail. FEB 2 6 2021
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Filing Date: Form must be completed and dated in the calendar year for which the ded eon is sought rI I! Form filed with:County Auditor
Must be filed or postmarked with the County Auditor or County Recorder o t th p rty is
located on or before January 5 of the calendar year in which the property t id Y DITOR County Recorder
See reverse side for additional instructions and qualifications.
Appr nt • .:r.grco ract bit r-te es<cti r
everse side) s `
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Ta ' eistric /legal descriptio Record number Page umber
Q. 10 llzumber
as 3a. a, �‘- oa7 2�2\ 100 2
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract' debtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of �applicatiop legal.or equitable owner?
/((//QQ!!//�� ['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: Is t e property in question:Annually Assessed
Real Property ['Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract s er 2
Address of mortgagee r contra seller(nu r and street,city,state,a IP 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 deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes No current year?
❑ ❑
Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract 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
Sign re of l�rRyA itor 21 L�e7//1/ � �,✓ County Date(month,day,year)
I/W 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
ow r/c tract buyer of the ementio d property on date application is filed.
Signature o rs II n Date(month,day,year)
2(o241Zo2/
Full re de ad ess ap icant(nu ber and street,city,state,and ZIP code)
feA I3Q E 2, on_ ? `k°n- 0,(1- 6 90 .
Person authorized by duly executed Power of)ttorney or by IC 6-1.1-12-0.7 Date(month,day,year)
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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.