HomeMy WebLinkAboutMortgage_Page (5) .,..s.... .t,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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'' ,F FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R14/1-20)
e , ' 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 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
See reverse side for additional instructions and qualifications.
Applic�t(owner or contract tau ye see restrictpss on re rse side)
((_' en I t2 UeQ. t Gar Ian aL. 6 _y__
Page number
�n / 6)9/ /2 4. -,7-0 2- Co- S- 112 -192-) 20. 3�9 6
Assess d value of al property as q" Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the
assessment date,current year 9 assessment date,current year date of application legal or equita wner?
art- /A6 3t)f) es ❑No
If no,what is his/her exact share of interest? If owned with someone o•' ah spouse,indicate with whom
7
If name on record is different than that of applicant,indicate below: pp 'the pr m question:Annually Assessed
/1 • \ eat Property ❑Annuall Assessed
Name Gof,,mortgagee or coot t seller �j —� ^ p n py
Addres of mortg gee or contract sell (number and street,city,state,an,
�,�('�/, �/ G,v '000 ��� Q� ��
Name of assignee or other owner or holder of mortgage �v t\Y/.� 9‘V
�` p O"1� ''ry/Address of assignee(number and street,city,state,and ZIP coc �`� a. P°O\.�C�
Does applicant own property in an If yes,what county? Has this deduction been requested vacant of deduction
other county on property for ❑ ❑ ` $°
in Indiana? ❑Yes o I current year? Yes No G�
A person is not entitled to this deduction unless the person has a 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 rec. ..ed 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 County Auditor County Date(month, ay,year
` )
/e'-A e•/i. �.}"k ZiRA, �7 .5 cs/L 4 D
d 2 2 2L_
certify under the penalty of erjury that th= =•o oregoing information is true and correct and that the applicant is reside t of Indiana and
owner/contract buyer of the a entione• • ••:' =rate application is filed.
Si re(owner's full name)X_______
Date(month,day,year)
,... _ � —
e
ull --e: ent address of appli n (number and stye t,cit,state,and code)
/5/9 ;V /
Person authorized by duly executed P er o Attorne ory l€8-1.1-12-0.7 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.