HomeMy WebLinkAboutMortgage_Meyer (12) .Ms.--. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
\\,gy FOR DEDUCTION FROM ASSESSED VALUATION
•;/-1'7 State Form 43709(R14/1-20) GI 650 n Ibn+g6Mtrl�, a.>--
N;--7-i.-% Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. orm fil 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.
Applicant(owner or contract buyer-see restrictions on reverse side)
Zo cbtAr_y Lee fvle'3 e r A- 32 n na 1 Pe M 2 y e T
Taxing Distric ,_\ Key number/legal description � 5 2 Record nurpper� age n �_
0 - 6 -t 8-/Co S 5 Sap-co 1. 5/6_ ^ I 2J c (f
of l property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment
a datelue ,currreaent year assessment date,current year date of application legal or equi,Wble owner?
I r 3o0, occ,_ ov es El 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
WIWI Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
�s.�s a..\ ,m r Tr-vs J- FILED
Address of mortgagee or contra seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
APR 2 5 2022 , /
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in a If yes,what county? What Taxing District? Has this deduction b s ��L)of deduction
other county ��/ on property for S(,lfi O Jt`1 t Y AUUI t V r�
in t rtiana? ❑Yes �l No current year?
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A ,alance on the person's mortgage or contract indebtedness that is recorded in the county
re / / t E ,� 2, A e"PC li corded in the county recorder's office)that is the basis for the deduction.
`� COUNTY AUDITOR
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Signature of ounty Auditor County ' Date(month,day,year)
'und- the •enalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
own- / •j ract •uy= of the aforementioned property on date application is filed. (((���rrnwwonnn al
Slpn= ers II n=fie) D,t / f a /
Fu =- •i tad :s of a-plicant(number and street,city,state,and ZIP code) yt r J
8 5 y51) i✓ D W ens vt I l e Zjv 476 s
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) 4A/
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. 1 s.I10710V