HomeMy WebLinkAboutMortgage_Perry (15) n,-;*. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS l ounty Township Year
_ % FOR DEDUCTION FROM ASSESSED VALUATION \�Of 0 ^/fi
State Form 43709(R14/1-20) Sal() 2 ' v 2 2.
b ,„ •�• 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 Recorder of the county where the property is
located on or before January 5 of the calendar year
Taxing District �ber l�
" I descri tio' 6 - Record number Page numbe
Q 2 - --b-17--o 3 OoO. 3 8.s—— 0 2S . 2022 2__Cit.4 .
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the a licant the sole
assessment date,current year assessment date,current year date o ppl�tion 00� legal or u' ble owner?
es ❑No
If no,what is his/her exact share of interest? If owned with s eo a other Ilan spouse,indicate with whom
If name on record is different than that of applicant,indicate below: I�s tY(e property in question:Annually Assessed
�}�( "roperty ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contrac r
Address of mortga c ntract seller numb' and street,city, ate an
Drawer NO 'Wag - a j�-
Name of assignee o them er f I.ge
r t2rflNO.
Address of assignee(nu an t e fate,and ZIP code) Card I"d
Does applicant own property in any If y s,what county? What Taxing District? Has this deduction n requested If yes,state amount of deduction
other county yy on property for Yes D No
in Indiana? '� JCR; o]ri.:.,w) current year?
A person is mg the person has a balance on the person's mortgage or nt ct 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 tha is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditpr — - County Date l t�qy, 01 Oa C7
�`/ >r 11 k„ - L
rr ar 1s !t o
I/We certify under the penalty of perjury that the=boy and •regoing information is t ue nd correct and that the applican is a resi ent of Indiana and
owner/contract buyer of the aforementioned prope • • e application is filed.
Xddrft(j natu (owners full name) ) ,,,iiiDate(month,day,year)
ber and street,4,staJ „e d ZIP code)
B �.�n Y\ -fir "-
Person .�`n `1 �.
authorized by duly executed Power of Attorney or dy IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
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The penalties for:Dentin/can inrhirt,imnricnrtm.ro..^t^*'•'^ .-