HomeMy WebLinkAboutMortgage_Houdyshell (2) ST. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS my Township Year
;te ri ' FOR DEDUCTION FROM ASSESSED VALUATION vIC) ZO2 Z—
}i I� State Form 43709(R14/1-20)
•" 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. ounty Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is El 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.
Ap•li - t(owner or contr.ct• -r-see restriction• • reverse side)
•str•ct I Key number/legal des• •lion number Page number
Ti • -7,2 Li 5 2
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As-�ed value o�perb as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of legaltor p'ciant the
e sowole?
assessment date,current year assessment date,current year date o application M
. ���{J�r ICC D Yes ❑No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
l Is the props yin question:Annually Assessed
If name on record is different than that of applicant,indicate below: I al Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or ntr se ler / O
Addres of mortggee or contract seller(r4ber and street,city,state,anc ^ N T
Name of assignee or other owner or holder of mortgage 111.1.4 CM
Z
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Address of assignee(number and street,city,state,and ZIP code) Z
O
_ _____ f yes,state amo duction CO
Does applicant own props in any I If yes,yy�h county? what - on property for
other county es ❑No ((// '' b Sr"-V� I current year? Yes ❑No
in Indiana?
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or ont act 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 offic )tha is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
//X-/� ! County Date(month,day,year)
Sign u e of County Audit ` I /_5 /2._ 9- 2,2_
I/We certify under the penalty of perjury that the above - •regoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property• :to application is filed.
Date(month,day,year)
Signa re( full njame)*f' &0 p
Full s ent address of applicant number Jsttr`e-et,cify, eje,a d ZIP co� Cif �� �� l
30 c� /by l �I7 r Date(month,day,year)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 42.0 —202_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.