HomeMy WebLinkAboutMortgage_Donnelly STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE
16
t"e`'" � � grown ship Year
r-^t`- a FOR DEDUCTION FROM ASSESSED VALUATION
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f =L,�� State Form 43709(R14 t 1-20) '
ice'-' ,- Prescribed by Department of Local Government Finance
ais
File Mark
INSTRUCTIONS: To be filed in person or by mail.
L � Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction' O qq Count Auditor
Must be filed or postmarked with the County
pl Ap, icant(owner or contract buyer-serve restrictions on reverse side)ae
lam(/
Taxi District
•
Zessed value of real property as of
number/legal description.- 4 •-e,0.4 . / 7.0- 0,1..E Record number021 Page number
Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appli ant the sole
assessment date,current year assessment date,current year - date.of applicatio • legato uitable owner?
JO/ OO O es ❑No
If no,what is his/her exact share of interest? If owned with someone otherthan spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller —
T FG a
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage �( I�
Drawer NO VVV llllllJ� I
Address of assignee(number and street,city,state,and ZIP code) Card 1�T 7� O a s_I
Does applicant own property in any If yes,what county? What Taxing District? I . :duction
other county c
in Indiana? ❑Yes k No c,,,,.,,,ycb,, ' u rvU
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or 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. .
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor L ' /e/ tir
County ,C Date(mohttf y a ^ i
��LLA le? ) l� S o,^ 3 . y ` l2•I/We certify under the penalty of perjury that the ovgoing information is t and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned pro ertypplication is filed.
Signature(own is full name) 7( Date(month,day,year)
10 7� 64 (lit-�, 1�
Full resident address of applican number and str t City,state,and ZIP code)
/ 3 3a r Gil/� ,�rK 4/7 ? O / l/`-ill c!% A/ /'
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)