HomeMy WebLinkAboutMortgage_Blankenberger (2) 1-14.,._ STATEMENT OF MORTGAGE OR CONTRACT INDEBT Township Year --1
4..f"ftt FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R14/1-20)
2020
Prescribed by Department of Local Government Finance i
File Mark
INSTRUCTIONS: To be filed in person or by mail. NOV 3 0 2021 Form filed with:
Filing Date: Form roust be completed and dated in the calendar year for which the deqthitz is sought. ,
County Auditor
Must be filed or postmarked with the County Auditor or County Recorder o t iougettre r erty's
located on or before January 5 o alendar year in which the property eyol f3 iriery El County Recorder 1
• _ _...............____
Applicent wner or contract bui _see riction on rev side)
1 "i ei,,e-t.• a ,, e. , _
FT g istrict Ke u ber/ egal d cription Record number Page number
- .300 - 4)00. 215-04
i A essed value of real property as of Mortgage i Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the a plicant the sole --i
a sessment date.current year assessment date,current year date of application legal or qui le owner?
es El No
If no.what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name onrecord is different than that of applicant,indicate below, Is the roperty in question:Annually Assessed
eat Property Ej Annually Assessed
Mobile Home(IC 6-1.1-7)
_......
Name of mortgagee or contract seller
573
Address of mortgagee or contract seller(number and seeet city.state,and ZIP code) —
Name of assignee or other owner or holder of mortgage . 6 (), -
-Address of assignee(number and street.City.state.and ZIP code) DI ow e r N 0.......... ......
______
Does applicant own property in any yes.what county? What Taxing Distriet? H
Card NO. ..... ... ..... _.... ....._
9%er,ic_or,u;,),ty
El Yes Cl
in 1 °a
A person is not entitled to this deduction unless the person has a balance on the person's r .._..-ss mat is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recct.er s orrice)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of,
1
20 _ 20 20 20 20 20 20
i Signature of County Auditor ^ County \IN _ Date(month,day.year)
i I/We certify under the penalty of perjury that the abov and foregoing information is rue nd correct and that the applicant is a resident of Indiana and
1 owner/contract buyer of the aforementioned property on date application is filed.
\)‹. Signature)owner's full name) Date(month,day year)
641'• --r-- ,,,---.."
,Fu resident . ress of applicant(number and see. .cit.state.a cad ZIP code)
' I-1501 g II 5C> -So .4-l--l-‘ AcArkkb..s 4-c a-1- -1(N) Lf 7(-,9 37
[-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)
I .
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.