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HomeMy WebLinkAboutMortgage_Rodgers ,o, STATEMENT OF MORTGAGE OR CONTRACT INDEBT NESS County Township Year �; - FOR DEDUCTION FROM ASSESSED VALUATION s "'s1= ZS State Form 43709(R14/1-20) * 1 �� .. Prescribed by Department of Local Government Finance 11.. 0�� File Mark INSTRUCTIONS: To be filed in person or by mail. MAR. g ed 2021 Form filedwith: Filing Date: Form must be completed and dated in the calendar year for which thededuction is sought. )(County Auditor Must be filed or postmarked with the County Auditor or County Record he ounty where t e property is !!!"`II located on or before January 5 of the calendar year in which the propel' COUNTY yab/e. ❑ County Recorder See reverse side for additional instructions and qualifications. AUDIToR Applic nt( r ozitract buyer- ee res cti s on reverse side) P l�Lap Cate_o__, Ta ng Distric / Key n tuber/legal description Record number Page number Ai/zet 04_ 064 ,92_ 61a" Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the pli ant the sole assessment date,current year assessment date,current year date of app i tion legal or i ble owner? �V O 9 zQ 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: Is a property in question:Annually Assessed y[�Real Property ❑Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller 0 • LLOa- O�x� Address of mortgagee.r c!' act seller ber city,stet , nd ZIP code)` # / ' ' 0 0l add �`1� V`IName of assignee or o er o 10or holder of mo 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 deductio ben 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 c nt ct 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. C-- Deduction approved in the amount of: (Y\ART6A2 Rob WIS (( 20 202) 20 ()Ave I' 1 QuE _ 20 Signa re C�Q,u/n Audito _ l�I— 0 ' ionth,day,year) alizzi I/ certify under the penalty of perjury that the above and foregoil is a resident of Indiana and owner/co act uyer of the aforeme do d property on date application is niea. Signature ull e) Date(month,day,year) Full re ' ent dress of app a number and st et,city, te,and ZIP cod�e) �13/2e721 r /-( We, /'2. , jj2/-&-ccz-v / ./ tir X 70 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) The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10.000.