HomeMy WebLinkAboutMortgage_Schafer (13) .,.4- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
A t FOR DEDUCTION FROM ASSESSED VALUATION G Q��oEca- ��
¢ �• State Form 43709(R14/1-20) `��„
, 7et.rns�l•P
' �� 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. D•---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 calendar year in which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications. /
Applicant(owner or contract buyer-see restrictions�on reverse side)
hev to d- 1.4 AA Set•`0 f€r Record number Page number
Taxing District Key number/legal description
ikkokAO' (owe.Shts -05--a?- f00-aol./ $lS -OD.7 a -7Sa
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid-as of Is Is tht he aplicntthe
sole
assessment date,current year assessment date,current year date of application 9equitable
5) OOv [aces ❑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 acoperty in question:Annually Assessed
la.<"eal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
z;� eC1-y FC-Li Aarx
Address of mortgagee or contract seller(number and slrei FILEDDrawer NO
Name of assignee or other owner or holder of mortgage d /\/ `/
Address of assignee(number and street,city,state,and Z Cal" NO. +.C,Y'/ N O y 1 0 2022
Does applicant own property in any If yes,what county? What Taxing District? I Has this deduction been uested If yes,state a ount of deduction
other county on property for
in Indiana? DYes ❑No current year? es N�n�1 o?`�,:na)
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract ft3hefirQMcOOAMITN tHldiROfithe 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 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
/1 AY' 'L.) I -24/ 6 t 6 '5. .-, I( /j v Jae)
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
owner/contract b y r of the aforementioned propert on date application is filed.
SignatuXowner's f e) Date(m th, ay,year)
Full resident a dres f applicant(number and sstrget, ity,state,and ZI ode)
i7(,y F %.s4-awn Qr ev.et- _ft.1 '476 7t,
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
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.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Harnq of applicant Name of mortgagee or contract seller
IZeiJ•v. a- ILA M Sak.o- -- L:.50er4 Fe Li
Amount of indebtedness Taxing District
Date filed(month,day,year) /���e J
l k/l o/c-x- 34 ,5 bAl.7 /� lam_ 7 w Vt /P
Key number/legal description
076-06-•-' oZ7-LICO —e otf• 81 5 —Dam
County Date(month,day,year)
Signature of County Auditor/County Recorder .cif G. r•b SO h
/V)tkf°}A) t,