HomeMy WebLinkAboutMortgage_Richardson (18) .Ms^ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES o ty i hip Year
4, 1 FOR DEDUCTION FROM ASSESSED VALUATION �2�
State Form 43709(R14/1-20) •
.r Prescribed by Department of Local Government Finance lJ
Y 5 202eie Mark
INSTRUCTIONS: To be filed in person or by mail. F rm led with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is so
Applicant(owner or contract buyer e restrictio n reverse side)
Toxin istrict ‘ Key number/legal description Record number Page number
�6 -fa - o6 _ a03 - 003__ 3Y9-oi8 . oxo Y .S3--
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
/aa 00 0 ❑Yes ❑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 the roperty in question:Annually Assessed
Real Property El Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller Ser`�'7
Address of mortgagee or contract seller(num and street,city,state,and ZIP code) -
Name of assignee or other owner or holder of mortgage Drawer NO C�_/�Y/711_//?0 -•.
Address of assignee(number and street,city,state,and ZIP code) 7�r Tl�-
Does applicant own property in any If yes,what county? What Taxing District? Has this c Ca 1 v 1 O. ��
other county on propel
in Indiana? ❑Yes E,No current year r •-- .— _
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or n ract 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 th 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,day,year)
I/We certify under the penalty of perjury that the Sbtve d foregoing information is tru and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
\/ Signature(Tiler's full name) r Date(month,day,year)
r Full resident address of ap r t(number and s et,city,st ,and ZIP code) e�
r
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.