HomeMy WebLinkAboutMortgage_Jaquess R STATEMENT OF MORTGAGE OR CONTRACT INDTDIES p•. ty Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14)
r•e „„ / Prescribed by Department of Local Government Finance AUG 31 215
INSTRUCTIONS: File Mark
To be filed in person or by mail. I l ri Form filed with:
X81' - •
Filing Dates: 1) Real be Property:Must be a ked with the dated in or County year Rad:tarc 7(-_1-/' tight. j
Must be filed or postmarked with the County Auditor or County Recct�SrrHHr�3PP a 7•/ / r�)(e/A��iQBty is / lam" County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
• •"•=nt(owner or contract buyer-see rest'ctions on rave%side)•
■ _ • II_._ • .h • ao /9J3
Toxin• ISM: ey num.41 •al des••n Record number Page number
3(0-1106 009 . o a o
Assessed value of real property as of Mortgage/Contract indebtedness unpaid f Mortgage/Contract indebtedness unpaid as of Is�a applicant the sole
March 1,current year March 1,anent�year date of application legal or equitable owner?
76?000 ❑ 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 different than that of applicant,indicate below. Is the property in question:Annually Assessed
'Klee!Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee� ra r to ller
`(
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
• Name of assignee or other owner or holder of mortgage 79, O00• 9-
Address of assignee(number and street,city,state,and ZIP code)
Drawer 1No...01003.'•
Does applicant own property in any If yes,what county? What Taxing District? • ..•; •'.•• lion
other county
in Indiana? ❑Yes ❑No Card NO.
A person is not entitled to this deduction unless the person has a balance on the pe. •••••• . .•., county
recorder's office(including any home equity line of credit that is recorded in the county recomer o .._
COUNTY AUDITOR .
Deduction approved in the amount of:
20 20 20 20 20 20 20 -
Signature of County Auditor I County Date(month,day,year)
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.
Date m th,da ye
Signature(owner's full name) (
�u asident address o� Vr-----a t, fe,a code) T._, —
/ (0 16 - andi-le a 4-9X-i 3(764-5
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 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.
ti
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� State Fofrt143709 (R4 / 10-01)
.«.
� Presai0e0 by Deparimen� W Local Govemment Finance �
� �INSTRUCTIONS: � � �ile Ma�
To be filed in person or by mail with the County Auditor of the county whe2 the pmperty is located.
Filing Dates: 1) Real Pioperty: During the 12 months betoie May 11 0l the year the deduction is fo be eflecfive. �,�n��
2) Mo6ile Homes assessed under IC 61.1-7: Between January 15 and March 31 of the year the �ct�n s fd� eHective.
See reverse side for additional instn�ctions and qualifica6ons.
,, 7 -- � /
see
Taxing Distrid "
� �_
Assessed value of real property as of
March 1, curcent year
If no, what is his / her exad share of interest?
is
_ `d' // .
or conVad seller
Address of mortgagee or conVad
side)
/ legal
Record number
V ✓ — / J��
QOCJGL�O��,� Pagenumber
J "�
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
applicant, indicate below:
(number and street,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et,
Does applicant own property in any
county in Indiana?
Deduction approved in the amount of:
20 y(L.�
Signature
state,
If yes, what county?
r�, �i'
If owned with someone other than spouse, indicate with whom.
state, ZIP
What Taxing Distrid?
COUNTY AUDITOR
20 Q�
P
County Auditor
Is the operty in question:
Real Property ❑ Mobile Home (IC 61.1-�
Has this dedudion been requested on
property for current year? � Yes ❑ No
20 �Z � 20��
Date
20
r�
We certify under lhe penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person