Homestead_Glaser (2) ,0_. o, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
to FOR DEDUCTION FROM ASSESSED VALUATION as
a`� I� State Form 43709(R14/1-20) G l�50✓1 Jo KRSO!'�
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
Applicant(owner^or contract buyer-see restrictions on reverse side)
De_�e,vt G' /A se Record number Page number
Taxing District Key number/legal description
ScANn.SOvN a G day -Z 0(0 7o
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is legahe l applicant
te sole
assessment date,current year assessment date,current year date of application 9equitable
F-1Ts ❑No
;r= er?
i , KOO
If no,what is his/her exact share of interest? f d � eone other than spouse,indicate with whom
Is the pr perty in question:Annually Assessed
If name on record is different than that of applicant,indicate below: eal Property ❑Annually Assessed
NOV 1 2022 Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller [ / &As D6 _oil
is fJ coy;o r•c.k ��\ 3 �KIK N Y AUDITOR
UDI;n R / % V
Address of mortgagee or contract seller(number and street,city,state, UNTY AUDITOR
Name of assignee or other owner or holder of mortgage at,z_A 0-7 0/ts /�
7-,u4 7 -0 ' /31 J
Address of assignee(number and street,city,state,and ZIP code) ,'f (��
Does applicant own property in any If yes,what county? What Taxing District? Has this dedue 6�i 4- D
oht on property fa
int Indiana?ercouny
❑Yes ❑No current year? Yes Li NO
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 I 20 I 20 20 I 20 20
County Date(month,day.year)
Signature of County Auditor I` `_ _ n 6. ( SoH I" `/D-
I/We certify under the penalty of perjury tJhatttthe Y`•above and foregoing formation 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)
Signs wner's full name) / `I'
'r / W 2
ull resident
f applicant(number and street,city,state,and ZIP code) -/ tLl
VI
ed 13 00 5 HA_Jb 5 4-Olc(T �✓" q 7 Date(month,day,year)
Person authorized by duly 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.