HomeMy WebLinkAboutMortgage_Lepeau STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
,d FOR DEDUCTION FROM ASSESSED VALUATION l 1 c9�n ��2�
a1 }: State Form 43709(R14/1-20) 1
' 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
located on or before January 5 of the calendar year in which the property taxes are first due and payable. County Recorder
See reverse side for additional instructions and qualifications.
Applican caner or contra•la.er- ee restrictions on reverse side)
Taxing District a nu ber7Te al desc' lion ecord numb Page number
OC — —1 -1 n a- 0°1 . 15-�;- 0 °- � � EMCZ
Assessed value of real property as of M rtgage/Contract indebtedness unpaid as of Mortgage/ ontract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of Iicat_r� 0^ legal oreable owner?
�L(/) U Yes El No
If no,what is his/her exact share of interest? If owned with som one other than spouse,indicate with whom
-If name on record is different than that of applicant,indicate below: a property in question:Annually Assessed
Real Property ❑Annually Assessed
10 ort ge
�� Mobile Home(IC 6-1.1-7)
or co cts er\
i,...ji.._
Address of mortgagee or contract seller(number a rest,city,slate,and ZIP coIL
,Y
Name of assignee or other owner or holder of mortgage DEC 3.0 ZOZZ
Ai f/YG
Q �!C-r�Ltt/L �.
D' Drawer N1 O. .OQ 4— .�� What Taxin tgN COUTIIMY lA X+Kvi: requested If yes,state amount of deduction
of •• '•••'• on property for
in current year? es El No
A I 7as a balance on the person's mortgage or ntr ct indebtedness that is recorded in the county
re. Card NO. -T 1 5o tt is recorded in the county recorder's office that is the basis for the deduction.
COUNTY AUDITOR
D
20 20 20 20 20 20 20
Signature off,County
dit _ County Date(mgn{p�da e ) 1�^�—...._
I/We certify under the penalt4y of perjury at the above and foregoing information is tru5,‘,._.s,,.
d correct and that the applicant is a re 'dent of'lndiana and
owner/contract buyer of the aforementioned property on date application is filed.
x
Signatur owner's full n,argl;) Date(moot
cy )�2 z
F esi ent address licant num rand street,at stcantre�d Z� ode
0 �\ kOly.\ 'h 0' k .
Person authorized by duly executed Power of Piltorney or by IC 6-1.1-12-0. 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.