HomeMy WebLinkAboutMortgage_Davidson (4) ,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
7,� t FOR DEDUCTION FROM ASSESSED VALUATION C
asp P State Form 43709(R14/1-20) 9 JO� ��
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. For
m filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property isCounty 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 cony act bu}ter-s Tres Lions on reverse side)
tit2. rc- 1 d/,/ter If L v/nsz3--
Toxin Dis ' Key number/legal description Record number Page number
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Assessed value of real op rty as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date.Curren ear assessment date,current year date of applicatio legal q _a
� er?
iLAZ-ZOi �z)C.D es ❑No
If no.what is his/her exact share of interest? If owned with sgmeone Othee than spouse,indic#with whom
If name on record is different than that of applicant,indicate below: Is the pr y in question:Annually Assessed
eal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of ortgagee coCntrayt setter
t_i
Address f mortga or ontrraact seller(nurrver and street,city,state,and ZIP code ,rO��u
Drawer NO a(
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Card NO. ' 47O
Does applicant own property in any es,what county? What Taxing District? Has this deducti be n request d ,state amou action['V i O
oth co on property forCV
in Inderianua?nty ❑Yes 0 current year? \ a
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or to tedness that is recorde cotJi C�
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)t at h basis for the deduction. t �e H
COUNTY AUDITOR Z
Deduction approved in the amount of: O - O
U
20 20 20 20 20 CO
20 a
ignature f County Auditor "//`."' / ID-Sr5Y1
County( c Date(month,day,year)
r�P
I/We certify under the penalty of perjury that th hove and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned p erty on date application is filed.
Date(month,day,year)
Sign re(owner's ii211naafi@) 1,,,, ��,, //- 7- ��-
a4nr
Full res nt address of ppli nt(number aand t,city,state,and IP code)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
//-7-2.D 2-�—
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.