HomeMy WebLinkAboutMortgage_TretterSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS —
- ' FOR DEDUCTION FROM ASSESSED VALUATION n Ty shi ; Year
ti � Sfa[0 FOrm 43709 (R4 / 10-01) •�
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Prespibed by Department of Local Govemment Finance D E C���� � 200
INSTRUCTIONS: File'Mark
To be filed in person or by mail with the County Audifor of the county where the property is locat rl �U� T Y AU01T0° .
Filing Dates: 1J Real Property: During the 12 monfhs be%ie May 11 of the year the deduction is to be ��BC�i .
2) Mo6ile Homes assessed under IC 61.1-7: Between January 15 and March 31 0/ the year the deduction is to be eHecfive.
See 2verse side for additional instructions and qualificafions.
Applicant (ow r or conNact b r see restridions on reverse side)
Taxing Distrid Key number / legal description Record number Q�
( / /� /�,�� ( ) / /y� /— O/q� X _ � Page number ��! /
�,�� �t�J \LJ FitJ(o � � !pd
Assessed vatue of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, curtent year ownef? ❑ Yes ❑ No
If no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home pC 61.1-�
me of moAgagee or contract seller
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Address of mortgagee or contrad seller (number and t et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and stieet, ciry, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for wrrent yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
Zo � Zo � Zo o Zo � zo Q'� zo � zo 0 9
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Signature County Aud'Aor Date
/ We certify under the penalty of perjury lhat the above and foregoing infortnation is true and corred and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Signatur ( wners Iull me) Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
Ful esident a dr ot a plipnt Address of authorized person
,('4. / 9� � H2 �,3
= o ,. 1' G
.fat: s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION T 4� �`�
' State Fo 43709(R13/10-15) 1Y..1. 1
Prescrbed by Department of Local Government Finance /
INSTRUCTIONS: • File Mark
To be filed in person or by mail. MAR 6 2017 Form filed with:
Filing Oates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought ,�/
Must be filed or postmarked with the County Auditor or County Recorder of the county ere the prope is Cl County Auditor
located on or before January 5 of the immediately succeeding calendar year. tri 0 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with ftpp����gqv 't ;rir .,.•unty County Recorder
where the property is located during the twelve(12)months before March 31 oI§tl7.A 0wi RaitattnUMANJTOR
See reverse side for additional in•, at and qualifications.
Appcant(owner orconaact buyer- on reverse ) +
CTa y l.(A V ea) number/ i%1 —/// 4-Yeti- 0/. 96a7-0-0,7 d numbpr Page 9-1S.
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 assessment date,apeigyearcoo date of application legal or equitable owner?
((,�//--��11//J` ❑ Yes ❑ 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'Memid than that of applicant,indicate below: Is the property in question:Annually Assessed
�(///,` j�(�j1 ❑Real Property ❑ Annually Assessed
�'."`• �"" ` Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sailer _.
a--_— —_._______.-- 1...._,,......wi slan-„a,,.ee,te.and ZIP code)
j R en-ETC ,514 cc! J
it_ru Oct- 9505
D What Taxing District? Has this deduction been requested If yes,state amount of deduction
at on property for
in current yeah ❑Yes ❑No
A I as a balance on the person's mortgage or contract indebtedness that is recorded in the county
rat t is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount at
20 20 20 20 20 20 20
Signature of Cou ty uditor County Date(month,day,year)
t e-A /2 L .k4-21.1 L baat,
T%We ce 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 I contract buyer of the aforementioned property on date application is filed.
S-WS" rrefs bull e) Date(month,day,year)
� of
Full r ant address of app t numbe and ,cdy.�taten code) �/
1�//J� /0' h - O1J (/�� ' 7.Q,' v(C/o.�ii��' !% 9 7�;
P rerson authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 / Date(month,day,year)
Address of authorized person (number and sheet 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.