HomeMy WebLinkAboutMortgage_Garrett (13) .s. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
: FOR DEDUCTION FROM ASSESSED VALUATION •
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_I `- State Form 43709(R14/1-20) t 6�h /K~ Pry as
e 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. [LI,. bunty Auditor
Must be filed or postmarked with the County Auditor or
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Applicant(owner or contract buyer-see restrictions on reverse side)
Prep-r-ice b d Del b;'e K G a r re 4-a--
Taxing District Key number/legal description Record number Page number
Mon+orovv‘e(-y 4-l"1 - fyi_ p00. & `o I - O a 1 01 6o/o
Assessed valu f real property as of Mortgage/Contract i debtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is le the applicant
the
e sole?
assessment date,current year assessment date,current year date of application 9equitable
own
s 2, O00 pyres ❑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 property in question:Annually Assessed
Name of mortgagee or contract seller
FILED al-Freal Property CI Annually Assessed
Mobile Home(IC 6-1.1-7)
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Address of mortgagee or contract seller(number and street,city,state,-a¢d�l 2le)2022 �/�lJ �� -
Name of assignee or other owner or holder of mortgage [L�1 tt 'Pile
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Address of assignee(number and street,city,state,and ZIFt5IPE30N COUNTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requesreu 1 ii yew,.Leta e,..�..•••..• •.-..
other county on property for �r
in Indiana? ❑Yes Era-0current year? 5 ❑No
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
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of Co ty Auditoret, County ♦ Date(month,day,year)
G I to So , a/a q/
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.
Signature(owner's full na ) Date(month,day,year)
Full(r�esiiddent address of applicant(number nd street,city,state,and ZIP code) /"�,�� —7 (/e
1 O/4' VI .1 ' /`0 7 O wPnSV I'`e. / 6`� Date(month,day,year)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
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.