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HomeMy WebLinkAboutMortgage_Selby 7",, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION • ( �' State Form 43709(R14/1-20) \��/� �2 G o 22 � -✓ Prescribed by Department of Local Government Finance 3 File Mark INSTRUCTIONS: To be filed in person or by mail. Fo 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 Applicant(owner ont ct buyer-see restrictions r verse side) Taxing District •,\y\l ��y num r/legal cription Record number Page number ©2- 2�-1 S-Z14-'?,.0Z- OOO . 2g7 - 0 26 Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgag /pli Contract indebtedness unpaid as of Is the applicant the sole assessment date,current year assessment date,current year date n legal or q table owner? o0Oo Yes ❑No If no,what is his/her exact share of interest? If owned with so eone other titian spouse,indicate with whom If name on record is different than that of applicant,indicate below: Is t property in question:Annually Assessed Real Property ❑Annually Assessed Mobile Home(IC 6-1.1-7) Name ot8ttgag/e'e of con a(�Seer 1,ILED Address of moVrt`gage_eeltor contract seller(number and street,city,state,and ZIP code) Name of assignee or other owner or holder of mortgage MAY 1 0 2022 Address of assignee(number and street,city,state,and ZIP code) lyl_ a . L. n 4' IT OR COUNTY AUDITOR Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction other county Yes No on property for Yes No in Indiana? ❑ ❑ current year. ❑ ❑ A person is not entitled to this deduction unless the person has a balance 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 recorded 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(mo day, ear) 01\'�� r>s Q _ sue^ - l0 2 2 I/We certify under the penalty of perjury that the above and foregoing information is ru and correct and that the applicant resi ent of Indiana and • ner/contract buyer of the a orementioned property on date application is filed. S e(. ner's full �me) Date(month, ay,yet Full f edel.7 addr i t(nmb f a nar and t,cit st e,a P code) Person authorized by duly executed Powe f ttorney 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 nenalties for nerinnr can inch wle imnricnnment nn in hvn and a half veers and a fine not to exceed$/0,000.