HomeMy WebLinkAboutMortgage_Ellis ,.. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
�\ �.'i State Form 43709(R14/1-20) G��0' CDs-- �f�o22_
Prescribed by Department of Local Government Finance J
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. County Auditor
Must be filed or postmarked with the County Auditor or County
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Applicant(owner 9rit�ct buyer-seer i tins on reverse side)
V�J \ 1 SCAN''\ t
Taxing District Key number/legal description Record number Page number
00SS 26-r3- 19 -2o( -o00 __37`�.- _o0� Z.o2o oq
Assessed value of real property as of Mortgage/Co tract indebtedness unpaid as of Mort age/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year dat f qppL ation legal or equitable owner?
V, Yes ❑No
If no,what is his/her exact share of interest? If owned with omeone othey than spouse, Eyes
indicate with whom
If name on record is different than that of applicant,indicate below: I t property in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mo gee or tract seller
iik1e,
Address of mortgagee or con ra T3eller(number and street,city,state,and ZIP code) FILED
Name of assignee or other owner or holder of mortgage
MAY 18 2022
Addr sspf v. nee(number and street,city,state,and ZIP code)
\ nl �
Does app nt� propertyany If yes,what county? What Taxing District? �fy� i If yes,state amount of deduction
other county OA Yes No sfry r. O�sAU®l`bR
in Indiana?
A person is no,--- ,d t th deduction unless the person has a balance on the person's mortgage or c nt act indebtedness that is recorded in the county
recorder's offi-e(inc ding a y 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 C un udit County \ ` ^ Date(month,day,year)
I/We certify under penalty of ' ry that the above and foregoing information is true ar d orrect that the applicant is a resident of Indiana and
owner/contr uyer of the aforemento ed property on date application is filed.
Signs re n na e) Date(mo , iy,D`/yeal 22_,
I res nt address of ap cant(number and street,city,state,and ZIP code)
0 > Ls ) CanVt 1'.� code,,)
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Person authorized by duly executed Power of Afton-y 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.