HomeMy WebLinkAboutMortgage_Burns (5) R•h STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS lounty Township Year
FOR DEDUCTION FROM ASSESSED VALUATION �O� n� ^rL2
'• State Form 43709(R14/1-20) i O(� !/v
's J 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. County Auditor
Must be filed or postmarked with the County Auditor or
_
Appli t er or contract b see restrictions on terse side)
�1Yh.S. L"' `J\
Ke nurpper/I ah/�lescriptt6ry,/, �r-7/� [�' -�Xt Record num r Page number
l.� zing 0 z / e Gam• f^ . _1- 0OO �--t S—o —8 (/ l ( '-3 1
111 _eesssed value of real property as of !(���V Mortgage/Contract indebtedness unpaid as of Mort age/Contract indebtedness unpaid as of :egalor eplictablehe owner?
/�\ �aJ�5a,sment date,current year assessment date,current year da of applipn ^00
�`.V�, V es ❑No
(1 `!"�In If owned with omeone oth�than spouse,indicate with whom
n�
` If no,what is his/her exact share of interest?
` Is property in question:Annually Assessed
If name on record is different than that of applicant,indicate below:
eat Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
FILE
1. �Name of mort gee or contract`�'ler ��C1 I _
~�`2 Address of mortgagee o contract seller(number'r and street,city,state,and ZIP code) APR 01 2022
Name of assignee or other owner or holder of mortgage A -L --, a
Address of assignee(number and street,city,state,and ZIP code) tiIHSON COUNTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? oHas n pthis deduction been requested If yes,state amount of deduction
o
in Indcounty ❑Yes ❑No currentyearf El Yes ❑No
in Indiana?
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
�r+/ T County c o/\ DatO(mo th\d eA ar) IA__
Signature of Coun A or �fVA> `] + ` y+0
I/We certify underthe penalty of perjury tha e e and foregoing information is tru and correct and that the applicant i a re ident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed. It__D emtt;d ea
XSignanesfull naame)Full resident a ss.90pplicant(number antstrfate,and ZIP code)
(Person au \` xec� ) r1f Date(month,day,year)
Person authorized by duly executed Powerrof Attorney or by IC 6-1.1-12-0.7
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.