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HomeMy WebLinkAboutMortgage_Martin (19) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year _ • FOR DEDUCTION FROM ASSESSED VALUATION bSo n �n nc2fov( * '' State Forrn 43709(R14/1-20) ` Prescribed by Department of Local Government Finance 1 File Mark INSTRUCTIONS: To be filed in person or by mail. e) - 'VD D - O 9lI0 Form filed with: Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. Ey County Auditor Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Recorder located on or before January 5 of the calendar year in which the property taxes are first due and payable. CI See reverse side for additional instructions and qualifications. _ Applicant(owner or contract buyer-see res s o Inn CC reverse side) < r� (.fiej 1 (`�� \J its n Record number Page number Taxing VIDistrict �rO J iKey6 number/legal descripti (/�J ?c1\nce 0 06-1 - 19-�)y oao. o g`f -odd I 555 D Assessed value of real property as of Mortgage/ indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the'Wapp is ant the sole assessment date,current year assessmentn da e,current year date of application er? /U,` , /Aso.pa ©'Ves ❑No If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom If name on nwrd is different than that of applicant,indicate below: Is the property in question:Annually Assessed IF' [i eal Property 0 AnnMobileally Ass Home ss(IC d-1.1-7) Name of mortgagee or contra seller Penri y /l(uc nA' �0 ) /// Address of mortgag or contract seller(number and street,city 6fa[a,an 1 - / ��yy Drawer NO... d r Name of assignee or other owner or holder of mortgagpii22 C (-.J/if/it55P�,,-.) GIRSf}N COUNTY AUDITOR 0 Address of assignee(number and street,city,state,and ZIP code) Card N O, in any If yes,what county? What Taxing District? Has this deduction been temu.,..._ fit of deduction Does applicant own propertyon property for Fatii�ndiana?oounty El Yes No current year? I'�les 0 No I 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 Signature of ounty Auditor County Date(month,day,year) ^NJ, -'f,7 6, ,b50-, 1/ 3/camD D . I I 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 owner/contract buyer of the aforementioned property on date application is filed. -----) rg ature(o is full n me) a(month,day, ar) ..�....4.0-4'S Ia a E' 670 cal Full residentsi,) a`dddss dre of applicant(number awaktu ,nd street,city,state,and ZIP code) Vacg. Person authorized by executl� ��ed Power of �eY or by IC�1 1 12tarriarNC�' t N 44 �� 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.