HomeMy WebLinkAboutMortgage_Richter (2) ., 770.:. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Courity
_i Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION ___
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S,a,e Form 43709(R14/1-20)' ' Gibson °±1
-,,,I;-...„„;_o_•:•:,.- Prescribed by Department of Local Government Finance ______
File Mark
INSTRUCTIONS To be fled in person or by mail.
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riling Date Form must be completed and dated in the calendar year for which the deduction is sought 1
EV, 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. 1 I County Recorder i
See reverse side for additional instructions and qualifications.
Applicant(r;.7ner or contract buyer-see restrictions on reverse see)------ --- 1
e!,.5 _d- -2/7te R _ R,,ch tir-e-
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:-Faxing Distret Key number I legal description I Record number 1 Page number --1
Assessed value c'real property 35 of Mortgage i Cc-'rat indebtedness unpaid as of 11`.1&g-aTieTCRTntract indebtedness unpaid as of Is Ire sop cant seje ---1
assessment date.current yea- assessment date current year 1 date of application lege'or equitable oziner?
' 600 i El Yes No
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irrO.what is h.s/hel'exac-,t share of interest? 1 If owned with someone other than spouse,indicate w'th whom
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Irf-!--rtzTre on record tialldifferent than that of appi cant.indicate belo, Is the ryoperty in question:Annually Assessed
, eel Property El Annually Assessed
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Mobile Home(IC 6-1.1-7)
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l NaMe-Cif rtortgage.e,or contract seller
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, )-1, erifc",ar ,Fle&e,.( Crei i (on __.._ _________.._ _IA'IL-1--1
Address of rnorTgagee or contract seller(number and street.cif/ state,and ZIP code)
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;"-Name of assignee or other owner or holder of i
r-A-ittdreS s of asslenee.(nurnher arid sreet.city i DEC 2 9 2021
, - Drawer NO
DO-eS----applicant omn property in any If yesT: )n been recism461) dyentikiteya.iftguction ll
l other!county C 1
ard 1 !
l in Indiana? pj Yes ri:4-4*(o NO. (,-(2-q/3— ri-4.1<s Li No
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A person is not entitled to this deduction urneus liar per aai,nue cs..,,,,,,,,-- -„--,..,—.,e...,....,_,,_ e. 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.
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COUNTY AUDITOR
i Deduction approved in the amount of
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20 20 i 20__ _ I 20 I 20 -'1
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.Signatur:of Couniy Au itor ..,, ,v..„._ I --
C ounty fr Date(month.day year)
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I t We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and I
owner/contract buyer of the aforementioned property on date application is filed. I
7-•§7-;. ,(one.r's f 'name) ,,Date(month day y_or)
• 4/... ...4"-e--4/14:62 ----- /'7--/2.1"4-49-2-/
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F,-r:resii-Te.77t-address of applicant-triJrnaer and street city state and ZIP code
14/ 2 3 _a___//eZA7.)-7 /../b/ ‘76- 35 -
Pers;n aathorized by duly executed Power of Attorney or by IC 6-.1.1-12-.0 7 I Date(month.day year)
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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.