HomeMy WebLinkAboutMortgage_Meyer (11) .0,.,.a, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township ;ear
FOR DEDUCTION FROM ASSESSED VALUATION Q 1.
_(3 State Form 43709(R14/1-20) G( �SQ h �6�+gera try �
's\_ i Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. onn fit 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 ❑ County Recorder
located on or before January 5 of the calendar year in which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Zo.C.bw.ry Lee file•i e r .- -Je n na / e e /v( e y e
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Taxing District` Key number/legal description /JdiS 2 Record nur r� gage number
- G -18-l�300o-CAD I . Sy6- OoZ I Ill��fl�, -2.I0 CD-3
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant eutl
Is the owner??
assessment date,current year assessment date,current year date of application 9 q
Ir 3oOt Q ._ o es LI No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is th roperty in question:Annually Assessed
InVI.Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
6dressoms �a.V ,,,�a-TNsf- FILED Address of mortgagee or contraef seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage APR 2 5 2022 7//
Address of assignee(number and street,city,state,and ZIP code)
What TaxingDistrict? Has this deduction b `/�`J s�4�. 0(�¢�j,,)of deduction
Does applicanton own property in a If yes,what county? on property for Sr�NO UIV 1 Y AUUI 1�R
other county ❑Yes NO current year? L�
in Indiana? _
A )alance on the person's mortgage or contract indebtedness that is recorded in the county
re pity, L"cy (zi 7c 0 A/el 1 4--• corded in the county recorder's office)that is the basis for the deduction.
C , COUNTY AUDITOR
_
as— / 955 20 20 20 20
Signature of ounty Auditor 0 I County Date(month,day,year)
,��/ G�_ , 5 so h 117 -57C
'und= the •enalty ofr perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
own / •r ract •uy- of the aforementioned property on date application is filed. %►tQ y�
Sfyna.' er's II n�'e) Date
;/l' n t f a
Fu :- •o t ad-- .s of a.plicant(number and street,city,state,pnd ZIP code) 7 �\
8 5 Y51) k7 oWeesvl /le S/) 47GC, 5
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 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$1 0,000.