HomeMy WebLinkAboutMortgage_LLC (15) ��smm . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r �t FOR DEDUCTION FROM ASSESSED VALUATION w`���gj-C-V Ap
a� State Form 43709(R14/1-20) �`7 """ -
`9. Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. F m f d 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 Recor a coup re the property is El County Recorder
located on or before January 5 of the calendar year in which the operty taxes are first due d payable.
See reverse side for additional instructions and qualifications. 0
Applicant.(ow er connc«t-ee yer-see restrictions on reverse side) ��
�[�ju) :' V e I de-
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Ting District Ke u ber/legal description ord n b Page number
.V t,� '�G-t 1 —1 S--202-C7 el.\ _ �3 8-02.E 3q t1 Le L
Assessed value of real property as. Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is legal applicant
eplica t owner?
le
assessment date,current year assessment date,current year date of application g �q u,�•
ig(1+ tgat aOD L Y4 ❑No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the perty in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
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Name of mortgagee or contrac,seller FILE
1)
ddress of mortgagee or contract seller(number and street,city,Ytat6 and ZIP code) AUGme of assignee or other owner or holder of mortgage {,/ 2 6 202 .
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Address of assi 2 6ol.Z ^
7^( Glp2
I � Taxing District? Has this deduct n-6Er �cFY``� to mount of deduction
Does applicant on property for ❑ W UDIT R
other county current year? Yes No II O
in Indiana? .n w� Q
A person is nc //✓'� / l 4` '�Ol�dance on the person's mortgage or contr t indebtedness that is recorded in the county
recorder's offi I 1 �rded 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
Signature of County Auditor County Date(month,day,year)
CC-N-NO-A-A Q-V Q311.E--, - 1 C_";<<r M.- 2 — - �
I/W certify under t penalty of perjury that the above a regoing information is true and correct and
.D.lA r�
that the applicant is a resident of Indiana and
ner/ n ac r of the aforementioned property on date application is filed.
ignatur (o e s ll e) e.
D to(month,day,year)
- ,�- •
u r ide a e o plicant n ,b�err antes c stag Md�ZIP code)n — ` C) 7 0 �l7
�Jv 1—\KVl J\( 1 l-'` l/ Date(month,day,year)
Person authorized by duly executed Power of Attorney or bytlC 6-1.1-12-0.7
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for oeriury can include imprisonment up to two and a half years and a fine not tr,a,rriaeri a+n nnn