HomeMy WebLinkAboutMortgage_Dozier (2) .ME�,�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESSCountyTownship
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�' <;► FOR DEDUCTION FROM ASSESSED VALUATIQN::or.
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v. State Form 43709(R14/1-20) ° Gson 02/ 2021
;;;v Prescribed by Department of Local Government Finance MAR
A p O 5
02' File Mark
INSTRUCTIONS: To be filed in person or by mail. ��
1 Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. 121 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
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
139,000 IZYes ❑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 the property in question:Annually Assessed
®Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Quicken Address of mortgagee or contract seller(number and street,city,state,and ZIP code) "LEDF
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) MAR 5 2021
Does applicant own property in any If yes,what county? What Taxing Di trict? s thi eduction•ee r e tgd If yes,state amount of deduction
other county pe f �Ar
in Indiana? ❑Yes ❑No I N COU� YSAU�Fs
A person is not entitled to this deduction unless the person has a balance on the person' ge 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 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 !^ County 1 Date(mdnt, ay,year)
I/We certify under the penalty of pen t the above and foregoing information is tru d correct and that the applicant is a sident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
x Signature(owne s full name) Date(mo thdr,�7
` (J
Full resident ad ess of applicant(number and street,city,state,and ZIP code)
211 M 3rd Ave, P'ton, IN 47670
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)
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