HomeMy WebLinkAboutMortgage_Grogan ,..Fr•,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
4 ' FOR DEDUCTION FROM ASSESSED VALUATION - Qo--o�o-
State Form 43709(R14/1-20) I bSon TownShjr ��
.? 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 calendar
Applicant(owner or contract buyer-see restrictions on reverse side)
A) Ic6lt A Ar09c"-v-x
Taxing District Key number/legal description ` Record number Page number
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Assessed value of real property as of Mortgage/Contract in tedness unpaid as of I Mortgage/Contract indebtedness unpaid as of Is the applicant
equitable the
e sole
Is
assessment date,current year assessment date,current year date of application 9
er?
/6 7, ' 7 ( S ❑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: I Is the pr erty in question:Annually Assessed
eat Property ❑Annually Assessed
Name of mortgagee q contract seller,
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Auaress of mortgagee or contract seller(number and street,city,state,and ZIP comb) Drawer r N O...d.0 1
Name of assignee or other owner or holder of mortgage FILED
Card NO. ...O.SS.`f
Address of assignee(number and street,city,state,and ZIP code) DEC 1 3 2022 _ _
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction bee quested If yes,state amount of deduction
':-!hi
ther county ,,--,,�� or):property for es ❑No
n Indiana? ❑Yes L.Srvo yearf
A person is not entitled to this deduction unless the person has a b , ge r contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorde'c]'t`n"t e coun recor er's o ice)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
County Date(month,day,year)
Signature of County Auditor I t
,w�, Gfbsoi'l /a/I3/0.. .
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 buyer of the aforementioned property on date application is filed.
Date(month,day,year)
Signatu (fie owners full name) / 7 _/1 -2 a
Full resident address ofofaapplicant(number and street,city,state,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.