HomeMy WebLinkAboutMortgage_LLC (2) ..�Itt , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
7� '4 FOR DEDUCTION FROM ASSESSED VALUATION CirbSon �e � as
State Form 43709(R14/1-20) 'Toys•Skle
a j 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. III.--Cbunty Auditor
Must be filed or postmarked with the County Auditor or County R rnrdar Qf the county where the property is ❑ County Recorder
located on or before January 5 of the calendar year in w)J' the property xes are first due and payable.
See reverse side for additional instructions and qualifications. (l_/"�-t II
Applicant(owner or contract bu -see restrictions on reverse side) �L17
;3w Qs,denf104 LL c.
Taxing District Key number/legal description o Record P u er
e� ^
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant
equitable the
owner?
Is
assessment date,current year assessment date,current year date of application 9 q
s-, f 00 1 -Yes ❑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 property in question:Annually Assessed
teal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee ppr contract sellerRrst . FILED
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owne A U G 2 6 2022 ',
_IlAddress of assignee(number a
fixing District? Has this dggwetl� SL to amount of deduction
Does applicant own property it ,� on propert�'FbY A ITOR
other county ❑ current year? Yes _No
in Indiana? Yes [ \
A person is not entitled to tJ ance on the person's mortgage or contr t indebtedness that is recorded in the county
recorder's office(including 'ded in the county recorder's office)that is the basis for the deduction.
�X
Deduction approved in the ar Ji � COUNTY AUDITOR
20 20 20 20 20 20 20
Signature of County Auditor � ounty • Date(month,day,year)
��I �� CL.\a te. --- G 11.S o, B/a-6,/.i.z_
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
owrrsfJ coJtra�buy of the aforementioned property on date application is filed.
Ona re( 9e f ull n e) Date,-t� e r L,
Nesi nt dd e o plicant(number sire,city,st�t�Pod ZlIPcode))�— ) T'5 J- moo/� �- � `I }\.1 't�]l� I' Date(month,day,year)
Person authorized my executed Power of Attorney of by IC 6-1.'I-f 2-0.7
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 Ain nnn