HomeMy WebLinkAboutMortgage_Leonberger (2) - -�,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' FOR DEDUCTION FROM ASSESSED VALUATION L �1
State Form 43709(R14/1-20) ibgtt., MJr t'�SOM C/t� �a
a J
's .� 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. , 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 the property taxes are first due and payable.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
fb.fisy2 r Mo.rV-- LJ nberge r
Taxing District Key number/legal description Record number Page number
MGt\ otvter'i 96)-ea,'- 00-004/- qCY 6a I 0�. - 3735
Assessed value o 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?
[]([_J1 pill a s ❑No
If no,what is his/her exact share of interest? If owned with someoneothher than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is�the property in question:Annually Assessed
(y'hteal Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller FILE D
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 U G 18 8 2022
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction�g(3g�}�e>jU SA 'i�`89nt of deduction
other co El ,:1, on property for rL—�_eess ❑No
in Indiana?unty Yes o current year?
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract 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)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
County Date(month,day, ear)
Signature` County Auditor �w /' r ®N 2/, S/
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.
Date(month,day,year)
Signatu ( ne full nam '
Fu resident addr of
pli n number a sire , ity,slate,and ZIP code)
3...3IA '7 *76- 5 ouJeA5 v t lle_ { "l-/ 766 Date(month,day,year)
Person authorized by dJly executed Power of Attorney or by IC 6-1.1-12-0.7
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.