HomeMy WebLinkAboutMortgage_Holmes (2) •—rda STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS my Township Year
( V 3 FOR DEDUCTION FROM ASSESSED VALUATION /1�' f/�1 ZZ
r.` State Form 43709(R14/1-20) O v✓ I
\\ Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. Form tired 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
'located on or before January 5 of the calendar year in which the property taffies are first due and payable. ❑ County
/R�ecorder� /�
numb r Pa e ndt
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Assessed value of real property as of Mortgage Contract indebtedness unpaid as of Mortgage/Contract indebtedness tine id as of- is theor plica bite owns?
assessment date,current year assessment date,current year dale o!app icali e9 q
(2Y,2e3 ❑Yes ❑No
If no,what is his/her exact share of interest? If owned with someoneother than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is t operty in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assigns . . •--.Does applicant owl • �,,,
county
�Qaa- [ ' V L Date Mortgage eduction
other cou nty Applied AmtMortgageeI
in Indiana? C
Applicant I Melanie
A person is not E /2/2022 I $ 98,000.00 I Old National Bank the county
recorder's office
li Holmes
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor Date(month,day.year)
/I, _. :
. i J I < • _.I _• -;:f
1/We certify under the penalty of perjury that the above- • oregoing informs ion is True and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property •n d.le application is filed.
3lgnet re(o� name .; _ Date(rrtontfr;tf
Vl A / ,I �
�/FuIIJeSicWnl addre' • appl cant(rtum••rand sflest,SIty state,and ZIP de) , 7 ��
Personrs authorized by duly executedvte Power of Attorney or by IC 6-1.1-12-0.7 G/y[-- 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.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of appl cant ;d / / _) Name of mortgagee or coruract seller
��//}y//1� /L-S.-e-i /[_r'L�r✓tY-LIrYL1/'eS OLD A6972D/K9L .�sMe
Date tiled(month,day,year) Amount of indebtedness Taxi g cttI �`u Ar--7
Key number/legal description
7-6-/e- 43 -zoo- e --/ ,z- 19z5
Si ature of County Auditor/County cor County • I Date(month,day,year)