HomeMy WebLinkAboutMortgage_Hipp (7) Ms5T STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
6* •�, _ % FOR DEDUCTION FROM ASSESSED VALUATION_ State Form 43709(R14/1-20) a,,, �i\
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✓' Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
F m 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
Applicant(ow or contract rrSgEjres fictions on er r�1�ee sstd
Taxing Dist c ` `` 'V Keyl u ber/legal destrn Record number Pata numbids
b2 1 —1-1 — u ,40 0 r-C.c_ . 23-9--(Da1 1q
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mort age/Contract indebtedness unpaid as of Is the ap licant the sole
assessment date,current year assessment date,current year date f ap qct legal or e u ble owner?
(J` 0�� es ❑No
If no,what is his/her exact share of interest? If owned wi omeon erithan spouse,indicate with whom
If name on record is different than that of applicant,indicate below: I property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of'moo gagee o contract sell
Addressl/lloff m rtgagee or con act seller�umb r and street,city,ate
N_L--P MA)Tbi z-- FILED
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) / 245/
AUG 1 2022
Does applicant own property in any If yes,what county? sted If yes,state amount of deduction
other county ��77 ,fI
in Indiana? ❑Yes ❑No I __.._.._,__. 1 Nk%�� Chi 1kyi.md)
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or crontract indebte� g(ygt Qog Pttl*JftAT.G Thty
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis or the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County i Dat (month,day,year)
�n_s \C? .S
,1J✓) 2 1-1-0 2 .
I/We certify under the penalty of perjury that the above and foregoi?lg information is a and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
KSig tf a re wner's fu am
`/ �� Date(month,day,year)
I resident addre applicant(number and str t,c' ate,and ZIP code)
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)
Tti.....,,,,,r.:..,.s...,,,,,,................a_:...,,.,,.........,.....,,,.,,ti..,,..,r+a hair„oars and a fine not to exceed$10,000.