HomeMy WebLinkAboutMortgage_Meyer (14) „,-,_5N STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.. -' 1 FOR DEDUCTION FROM ASSESSED VALUATION /' ,,
State Form 43709(R14/1-20) Cat--//�50„ ?rill cej"h
1;--' 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 CI County Recorder
located on or before January 5 of the calendar year in which the property taxes are first due and pay��ab\\le.
See reverse side for additional instructions and qualifications.
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Applicant(owner or contract buyer-see restrictions on reverse side) , �� ^0J L,t\
2c cl,m� L•ee Meltei- 01" y
Taxing District Key number negal description Record number Pa numb
Pr•V\ceto,1 -- - mil- l 2�2� 1 i SAssessed value of real property as of tsks,
ortgage/Contract indebtedness unpaid as of Mort a ontra ind`eb4 'mess unpaid as of Is legalthor eplicant the sole
owner?
assessment date,current year sessment date,current year date of application �with
-43 Q � C _ 0.YE� ❑No
If no,what is his/her exact share of interest? If owned with someone other than souse,in ica a with whom
If name on record is different than that of applicant,indicate below: Is the roperty in question:Annually Assessed
riW-Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ,.[� Q��
pc'.no S \I o.\\e-, 0,4 - Tr-c,'F - � -Q - (vc.4 C` J
l)
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
-1V Name of assignee or other owner or holder of mortgage WI(
Address of assignee(number ands A rr•Z •' Wk 2 222
1 • ,�r�t'? A ” What Taxing District? Has this deduction been reque ted a amount of deduction
Does couro.an� /t �' �( y on property for -(OR
other counr• A� current yea o VO\
in Ins (�
A p, rnis deduction unless the person has a balance on the person's mortgage r t ebtedness that is recorded in the county
reco ,,,rcluding any home equity line of credit that is recorded in the county recorder's offs t rat 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(1l.��onth,day,year) ^�
1 (\\l,� -Vim—'�W-� K� `/� r-r l \— C (��1�V t l aces! Gam'(
I I W ce ify n r th penalty of perjury that the above and oregoing information is true and correct a that the applicant is a resident of Indiana and
/ p a buy of the aforementioned property on date application is filed.
Date( onth,day,year)
i�na r (o t• s II na ) — c�
•
Fu I r en ddr s f applicant(number and street,city,state,and ZIP code)
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$10,000.