HomeMy WebLinkAboutMortgage_Grounds fa STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
_~y _ FOR DEDUCTION FROM ASSESSED VALUATION
'' ._ ' State Form 43709(R14/1-20) Gson 026 2021
'� �" Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. 1371 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 taxes are first due and payable. ❑ County Recorder
I
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Grounds, Derek J/Carmen L
Taxing District Key number/legal description Record number Page number
026 26-19-19-103-000.132-026 2021 6247
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?
145,000 ®Yes ❑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
Ia Real Property ❑Annually Assessed
LED
AddressMobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller k
-� of mortgagee or contract (number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage , _C 22 2021
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 iiiNufa yeA�)�r� yes,state amount of deduction
other county on property for ®Yes ❑No
in Indiana? ❑Yes ❑No current year?
A person is not entitled to this deduction unless the person has a balance on the person's mortgage 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's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
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Signature of County Au ' (\\ ( County Date(month,day,year)
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I/We certify under the penalty of perjury that the oregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buy oft aforementioned property on date application is filed.
xSign caner' ull e) Date(month,day,year)
ul rest nt a ress of appli number and street,city state,and ZIP code)
906 S Lincoln St, Ft Branch, IN 47648
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.