HomeMy WebLinkAboutMortgage_Miller (33) 0 � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
,A FOR DEDUCTION FROM ASSESSED VALUATION 9 �/7�rr
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v.3 v State Form 43709(R14/1-20 !/\ 1
q:.•-ii Prescribed by Department of Local Government Finance
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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. 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
Applicannerorcontra r-fe restriction on everse side)
TaxingAstrict Key number/legal description Record number Page number
C 2 9— 2C-12--1b-2ao-00o,4 on- - - . 202-- 2$ 3--
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortg e/Contract indebtedness unpaid as of Is the ap li nt the sole
assessment date,current year assessment date,current year date.of application legal or ,table owner?
\2v1 t000 Yes ElNo
If no,what is his/her exact share of interest? If owned with s eone othel-than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: t property in question:Annually Assessed
- Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ____ -----
Address of mortgageegee or co ct eh. i ber and street,city,state,and 2 4_ o c r` - 1- ---
-.'t
Name of as r r or holder of mortgage Drawer O................... .
,_
. '
Address of assignee(nur et and iii,
stc f,city,state,and ZIP code) •
0 .......
M Card NO. ..............
Does applicant own property in any jY�r$aunty? What Ta: to amount of deduction
ether coup y ❑Yes Z�I ZLvO`�0
P �n�yearn LJ reS U No
A person is no td �eduction unless the person has a balance on the person's mortgage-or contract indebtedness that is recorded in the county
recorder's office0, bring 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 County Audito County Date(month;day,year)
1/We certify under the penalty of pe ' ry t he above and foregoing information is tr and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signattir (owner's full name) Date(month,day,year)
Full r ' ent ad ess of plicant(number and street,city,state,and ZIP code) 1
Person authorized by duly exectited Power of Attorney oj by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)