HomeMy WebLinkAboutMortgage_Jines (7) ,a moo, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C unty Township Year
%' FOR DEDUCTION FROM ASSESSED VALUATION � \ ��� ���Z
State Form 43709(R14/1-20)
✓ Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. Fqrm�led with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. pQ County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is L 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)
2/„ ti.4- /nt. Oil-- (11L��
Taxing District Ke umber/legal description Record numb,r Page nyb
4-oka-Be ns 2 -iz-o5-4-oo- . 997-- �fQ 7 "7 r 22-c
Assessed value of real property s of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the a icant the sole
assessment date,current year assessment date,current year date of application legal or unable owner?
iqr, Tr�-1 r Grif . 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: s t property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name/� of mortgageel or contract/� seller
/r�.ertf l�/o//a d `.. 726S lav,9 4.4k i✓/�q /rUSt- o
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) .J at
rn TIy J
O
Name of assignee or other owner or holder of mortgage Z .
O
Address of assignee(number and street,city, 1-<:
< u
Does applicant own property in any If yes, ' ! QYY� �� \ S eduction en requested If yes,state amount educt o `ri J
other county ❑Yes ❑No `^/ 1 v1 P 5 ar? Yes ❑No rNv y
in Indiana? fi \ '\e C\ Q�Y� ,� /
A person is not entitled to this deduction \ e or coot t indebtedness that is record, in the count
recorder's office(including any home eqi )ffice)that is the basis for the deductiort7J
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signs re of County Auditor -�, County n n Date(month,day,year)
�t/:�%_ci 2/: ,�!i sea, ytb scat ,s'/2 a 0 - .
I/We certify under the penalty of perjury that the above regoing information is true and correct and that the applicant is a resident of Indiana and
own /contract buyer of the aforementioned property o application is filed.
Sin gs /re(owner's f ham Date month,day,year)
IL
Fu sid nt address of applicant(number and street,city,state,
��7a/r�f�,ZIP code) �,r-,,, �jI
p)C1— 7 1�LlJ/,-- le0 r / �1-lrte-(2�'7-474-, ( -iV If-7 Co-7. )
(month,day,,year)
Person authorized by duly eadcuted Power of Attorney or by IC 6-1.1-12-0.7 Date
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.