HomeMy WebLinkAboutMortgage_McKannan (6) ç. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R14/1-20) 6 1 b .5o h FrOWC.SGO
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. [g 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.
Applic�anyt(owner or contract buyer-see restrictions on reverse side)
Kevin R /✓kkznnan
Taxing District Key number/legal description Record number Page number
Fc��C•x0 496.-13-IA— 20a,WQ. i "71 -6O da .2‘ g C
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?
3 2 cc Npres ❑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 perry in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract slier
[re e.r: ,e -tre c-�1 C�,e. •A- U IP.o FILED
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
a JUN 0 7 2022 /
Address of assignee(number and street,city,state,and ZIP code Drawer N O ` �/
Does applicant own property in a If yes,what county? al 4W mankIie�
other county �" Card NO. B ON COUNTY AUDITOR
in Indiana? ❑Yes No
A person is not entitled to this deduction unless the persor sss that is recorded in the county
recorder's office(including any home equity line of credit tl _, .,..t.,...or the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of C unty, uditor CountyDate(month, ar
I/We certify under the penalty of perjury that the above and foregoing information is true 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(ow es' full name Date(month,day,year)
Full t ddress of applicant(number and street,city,state,and ZIP code)
ro y S F- rsi- S-I- Fr-A✓.0,5Co 7./t/ 4l 760 Lr j
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.