HomeMy WebLinkAboutMortgage_Bottoms (4) M•_•q, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
44 � FOR DEDUCTION FROM ASSESSED VALUATION \ (/�J
/J State Form 43709(R14 I 1-20) s•&) 00 ��I_
¢ /.y� Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. F rm 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 Recorder of the county where the property is County Recorder
located on or before January 5 of the calendar year in which ti)e.property taxes are first due andpayable.
See reverse side for additional instructions and qualifications. ,
Appli tt(owner
or on ((buuyyeer-see r bons,on reverse de)
,� l` , ,`w" -\ l Record numb r Pa epym r
Taxing trio Key nu er/legal descr .ion DG /' O0 ,- 2_O 1 6 2'C /�
2 -\ 1�- o1 -000. b 6 0 J
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortg ge/Contract indebtedness unpaid as of fs legal applicantr b te he sole
assessment date,current year assessment date,current year date o ppli t�
000— Yes ❑No
If no,what is his/her exact share of interest? If owned with s meone oth E than spouse,indicate with whom
If name on record is different than that of applicant,indicate below:
s t e property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contr— ter `
Address of mortgagee or contract seller(number and$ / —_ FILED
Name of assignee or other owner or holder of mortgac "�
JUL 0 8 2022
Address of assignee(number and street,city,state,ai
in b ue a Ii, P4i170 deduction
Does applicant own property in any If yes,what county? y`""""`-�ot roperty f
her county Ell yes ❑No 1 oncurrentp year? YOB COUNTY AUDITOR
in Indiana?
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or ntrac ndebtedness 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
County \� _/� D to mo ttlai.ye�r)�
Signature of County di orC6?) `r \ CC//��
uar,A •
I/We certify under the penaltyof perjury that the above and foregoing information is tru and correct and that the applicant i a re dent of Indiana and
owner/contract buyer of the aforementioned property on date application is filed. q11
DateL.f13Y.1Y7
Signaiur`/`/(imA/o�/wtn/e\rs full name)— ,� L VO Il
C�1d1e`nntt address((ofJl appli (numbecrrannddstrreeeet,city,state,and ZIP code) 1 ` ^� / G
v O V � - , \ tl (� l Person authorized by duly executed Power of Attorneyfr by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
rtie r,or,altrec fnr neriury can include imprisonment up to two and a half years and a fine not to exceed S10.000.