Loading...
HomeMy WebLinkAboutMortgage_lloyd (7) <0..._*•>.q• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS �ounty Township Year 1 % FOR DEDUCTION FROM ASSESSED VALUATION CC �7 �\� `;1 State Form 43709(R14/1-20) 71. J 13�• 4— ^y^ �G Prescribed by Department of Local Government Finance V\tom, • 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. ©ounty 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 in which the property taxes are first due and payable. ❑ County Recorder See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) D—e—X"%c\t.e i....kOeS ,[. Taxing District �., I Key number/I al escription Record number I: a numbe i {)o. kin \ CI ,Jn -LQ-c -t- `ate-low- ocDo.3l7_-- co. OZZ- ` O Assessed value of 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 p¢) legal or equitable owner? cS 3cp 0O _ i es` ❑No If no,what is his/her exact share of interest? If owned with someone otherf� than spouse,indicate with whom If name on record is different than that of applicant,indicate below: Is theproperty in question:Annually Assessed j^` Lr]�1 Real Property ❑Annually Assessed 1L Mobile Home(IC 6-1.1-7) Name f mortgagee or contract seller \\ -n "kb Address of mortgagee or contract seller(number and street,city,state,and Zlec e) 06, L+ Name of assignee or other owner or holder of mortgage ci it v 204, Address of assignee(number and street,city,state,and ZIP code) N Co( l �__te�r�+ AVO i Does applicant own property in an If yes,what county? What Ta5i District? Has this deducti r en requested If yes,state amount of deduction her county a on property for es ❑No in Indiana? ❑Yes - current year? UW A person is not entitled to this deducti ss lie person has a balance on the person's mortgage or contract indebtedness that is recorded in the county recorder's office(includin h ui ine of credit that is recorded in the county recorder's office)that is the basis for the deduction. co COUNTY AUDITOR Deduction approve the adf: I 20 20 20 20 20 20 20 Signature of County Auditor County Date(month,day,year) `.4ec Q • 41,A4 .-►J1 Cc Co Sc - 1f--alsz -iO0. II We certify under the penalty of perjury that the above an foregoing rmation 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. Sign ture(owner's full name) Date(month,day,year) '1y, lte��a fit, . , -a�-OQ�a� _ ull ident addressyf applicant(numbe k •street,cUi;state,and 'code) -I L, ( • Person authorized by duly executed Power of Attorney or by 1�1.1-12-0.7 Date(month,day,year) 41 Address of authorized person (number and street,city,state,and ZIP code) The nenalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.