HomeMy WebLinkAboutMortgage_Dayanan �� *;. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C unty Township Year
_,,�, _ FOR DEDUCTION FROM ASSESSED VALUATION `` \ 0 r/) Oo ZZ
a'� h State Form 43709(R14/1-20) �J� ( l `�
Prescribed by Department of Local Government Finance J 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
��
App nt(owner or contract bu r see restrictions on rever ide)
srn ,Vne1 . T L�z1VA'r4 1 cf
Key^number/legal detion `r Rgcord number Pa a J�um er--/
Taxing Qistrif[ 6 — 02.3 '1�`7 5� y—
t`C,JI L �G-tZ- Off- -�olt -do 1. 1 ( �J 1
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 date of application legal or��qyy''table owner?
assessment date,current year ®Yes 0 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 t e property in question:Annually Assessed
Real Property CI Annually Assessed
Mobile Home(IC 6-1.1-7)
NameTrtgag e or contract sell ,.,/�� �`
Address of mortgagee r ct sellerse (number_ lpa.Jn`d street,s city,state,and ZIP code)
FILED
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) DEC 2 0 2022
Does applicant own property in any If yes,what county? What Taxing District? c s thisedteduocrtio be to re 'ester ed If yes,state amount of deduction
other county �Yes ❑No t�rff__�1dK ff�F.GC 4 'LLi
in Indiana? y qt�t)
A person is not entitled to this deduction unless the person has a balance on the person's l(rid ataIo5' ict iM" tiei e s 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)the is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 \20 20 20
County \ Date�Nqn day,year)Signature of CounMdilpr \1-n- . 630
s. � ( L 2/ `a 2, -'
I/We certify under the penalty oY ,f perjury that the above and foregoing information is true a d correct and that the applicant is relsi ent of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Date(month,day,year)
4 Signature(owner's full name)
Full resident address ofa-p{p�lic�a�t(number nd street��ity,slate,and ZIP c�de�� — �' / �
0t8 S d 1�+kij, S ) 1 -Ir by IC ,1— L9 Date(month,day,year)
Person authorized by duly executed Power of Atibrney or by IC 6-1.1-12-0.7
Address of authorized person (number and street,city,state,and ZIP code)
The nanaltias for neriunr nat.,inrb trfa%m^^^^^--'--'.'-`- ` - --'- `-". ""4'f;r,o not to exceed$10,000.