HomeMy WebLinkAboutMortgage_Jones (22) .,.,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS county Township Year
/f t FOR DEDUCTION FROM ASSESSED VALUATION � (/ \� I �,Q Z
'5' �a State Form 43709(R14/1-20) T_\ '7\ 0 `� ✓ -�
Prescribed by Department of Local Government Finance
File Mark I
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 calendar year in which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buy r- :/s son reverse si/de)
/
TaVstrict Key number/legal description Record nu ber Page numb
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application � legal or equi owner?
-- ,o.' 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 rty in question:Annually Assessed
eal Property D Annually Assessed
Mobile Home(IC 6-1.1-7)
Name J A
of mortgageeor contract
vfco�tract seller
(CY_ /%/F `,1G i 4-2I_ -
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) ���
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Name of assignee or other owner or holder of mortgage D I a 11'C I- N O
Address of assignee(number and street,city,state,and ZIP code) Card 1,�t O• q 5-8-
Does applicant own property in an If yes,what county? What Taxing District? Has this ded _
other county on property
in Indiana'? ❑Yes YYJJ No current year
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
is-CO
Deduction approved in the amount of: la
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20 20 20 20 20 20 ^ N ¢
CID >
Signatur of County Auditor
County Date(month,day,ye r) ,--1 E
� a,r a o� A- AI D ,hs( /2- /e.,,- w
I/We certify under the penalty of perjury that the above an regoing information is true and correct and that the applicant is a residen of In iana g1573
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owner/contract buyer of the aforementioned property on date application is filed. to
/ Date(month,day,ye r)Lm4 �,` m
X
Signature wner's full nam J\O
Full resident addres app ant numb'street,city, ,and ZIP code)
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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.