HomeMy WebLinkAboutMortgage_Dillard •,,, ,_.:7.,,,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
" --•. ''.s. FOR DEDUCTION FROM ASSESSED VALUATION
\
1-.--.- •'''.'h In 2-0. .20 21
State Form 43709(R14/1-20) SKY)
,-i-a-4' Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. F rm filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. 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
Applicant ner contract r(Err-see rstriptions on.—.m‹,rseVA...A
e ct HilrAtke,. legal
Taxing District Ke Err/lege description Rqe7.4. 2)1 nu1qr.a Patriger
cyzs • -1\- -_,sol -(-.)ozc.-.)2-2 . .
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortga /Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date applicatien legal ore u ble owner?
31 0 0 es E]No
If no,what is his/her exact share of interest? If owned with meone oth1 r/than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: I he property in question:Annually Assessed
Real Property El Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of moN\jga ee ttract sell/"
I/5-1z2_
Address of mortgagee or cont n-eller(numb r an street,city,sh
01-karrji ----n-ef- 49e,- ---14-nj?-11/Itc.
Name of assignee or other owner o r o ortgage i
Address of assignee '(.$ n.‘, an t,city,state,and ZIP code)
4s....01
r , kl( 1 i 61-91-- Ca p i 14,A. . ---n vzes/rytee2y-
oot 1
t I 3ci, -2'10 -06
Does applicant ow roperty in ans./1W Ks,w hat cou . 1 v v g lat 1.7,1119 LASIrICt e Has this deducti be requested If yes,state amount of deduction
other county Ion property for
in Indiana? Yes Olo current year? Yes E]No
A person is not entitled to this ded ciOrvies the person has a balance on the person's mortgage o contr t indebtedness that is recorded in the county
recorder's office(including an bity line of credit that is recorded in the county recorder's office)that 1 the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the itAmt of:
20 20 20 20 20 20 20
--
Signature of C\kolvdito ,_ County Date(mo, •a year)
1/We certify under the penalty of perju at bove and foregoing information is true and correct and that the applicant is - esi•ent of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
vSignature(owner's full name) Date(month,day,year)
e-4_1—R A,,,e4.—/1A.
/.s. Full reside dress of applicant(number__and street,ci tate,and ZIP ri,....vo
\ko _‘ (-1- 1\t Lk..--q-ctr \ -r) -D{) -\-A- -- —1 D
Person authorized by duly executed Power of Attorney or by IC 6-1.4-12-C).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$10,000.