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HomeMy WebLinkAboutMortgage_Byrd wnship Year STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS — To 7!"Ifi, FOR DEDUCTION FROM ASSESSED VALUATION c:vilittitfr ) State Form 43709(R14/1-20) 1 13 2020 ••,,---, ---:-',- Prescribed by Department of Local Government Finance Nov 3 File Mark INSTRUCTIONS: To be filed in person or by mail. U 202 Form filed with. — Filing Date: Form must be completed and dated in the calendar year for which the deduction is sou . County Auditor Must be filed or postmarked with the County Auditor or County Recorder of the county coptrir.a._ located on or before January 5 of the calendar year in which the property taxes are firs JPeS01111 '"' County Recorder V See reverse reverse side for additional instructions and qualifications. i Applican aler or contract b Cr e restriction n reverse side) egaljuipscription Record nurnber P..9r ,, Dr As ssed vale of real property as o Mortgage i Contract indebtedness unpaid as of Mortgage/Contract indebted ss unpaid as of Is the applicant the sole assessment date.current year assessment date,current year date of application , legal or equitable owner? 1 6, Dyes 0 No 'If no,what is his I her exact share of interest? If owned with someone other than sOiouse,indicate with whom If name on record is different than that of applicant,indicate below. Is th property in question.Annually Assessed Real Property 111 Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller aied:3 ddress of mortgagee or contract seller( umber and str it,.state. . d ZIP code) - ---- — Name of as i or other er or holder m g 6c-- I 11 /9'.-C:? -''. , Annress of assign (number and street,city,state.and ZIP code) Does applicant own property in any If yes.what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction 1other county D yes El No current year' [I]Yes 0 No Llti1ndiana.2 A person is not entitled to this deduction unless the person has a balance on the person's mortgage or co---------------,-—CP recorder's office(including any home equity line of credit that is recorded in the county recorder's office)ti eti. 1 toa DI.i - COUNTY AUDITOR 0:% -(L2 I 'Deduction approved in the amount of Drawer NO 20 20 20 20 20 LILISD 1 Card NO. ...r.lcarborNot Signet. of C unly itor e 1County -eizArIA OR a 1 I/We ertify under the penalty of perjury that the above a ell------' 1Ifrigt:)1r--I- information is true and correct and that the applicant is a resident of Indiana and owner/contract buyer of the aforementioned property on date application is filed. Sign - r full name Date(month,day year) st,j1 4.0 I Full resident address of a licant(number and street.city state and ZIP ode) . \ . L--, N ./0 LLIWOO Herson authorized by duly executed Power of Attorney or by IC 6-1.1-12-0 7 (r Date(month.day year) i 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 510:000.