HomeMy WebLinkAboutMortgage_Bean x°o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
- -S ` { FOR DEDUCTION FROM ASSESSED VALUATION
et-re.:7 "1 State Form 43709(R12/6-14)
..;i.�a Prescribed by Department of Local Government Finance
INSTRUCTIONS: II ark
To be filed in person or by mail. di t1�
Filing Dates: 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 where the property is i Auditor
OCT (�rry
located on or before January 5 of the immediately succeeding calendar year. o'L My Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county
where the property is located during •-twe/ve(12)months before March 31 of each year the deduction is sou .
See reverse side for additional instructions and qu. .tions. ���
Apprca4 ero co ,Tact buyer- e restdctio o wide _ /� C'I'ggON COUNTY AUDITOR
r•istn Key ber/le al esmptio / Record number Page n tuber
Q� 0 cd Joe fx�d.v3`?�—D�0 07a/0 /4c
value of real p as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current March 1,current year date of application legal or equitable owner?
. ❑ Yes ❑ No
If no,what is his I 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
Real Property ❑ Annually Assessed
��/q�///1 /\ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller �,r�../`-'c�
Address of mortgagee or contract seller(number/land street,city,state,a d ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
0-41L60
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction een requested If y tate amoun of deduction
other county property for
in Indiana? ❑Yes __O No_ _ current year? 1_1 Yes ❑No
A person is not entitled JO/0 _ /70s- erson's mortgage or contract indebtedness that is recorded in the county
recorder's office(incluc unty recorder's office)that is the basis for the deduction.
Drawer NO JOITOR .
Deduction approved in the
20 - Card NO. 20 20 20
Signature of County Audit aunty 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.
Signature(owners full name) Date(month,day,year)
F I resident address of appf nt(number and street,city,state,a ZIP code)
x =0 g �ct/c_/ . r- lit Al,, Livt_- 2717 e lv�
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 510,000. -
"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun'
__ FOR DEDUCTION FROM ASSESSED VALUATION
• SUta Fortn 43709 (R11 I 6-09)
�,,,� � PresaiEed by DePa�M of LoW GovemmeM Finance
INSTRUCTIONS:
To 6e filed in person w by mail wdh the CountyAUditor or Counry Recorder o7 the counry wFie�e the propeM is located.
Fitirrg Dates: 1) Real Pmperty: Must fi!e dunrg Ne year for which lhe deducGon is sought.
2) Afo6de / ManufeCu2d Homes not assessed as Real Prz�perty Mrist file dunrg Ne fweHe (12J rtwnths
6efwa March 37 0/ each yeer the deduction is sWght.
See reverse side fo� additional insfr�ctbns errd qualifications.
I.Aypficanj.(ywreruoontrartbuyer-¢ee mreversasi0e) � �
d va� of re� pa�ty as of
, a+renl year
at ts ha / hu erart share ot u
on leoold 6 tlilfe�ent Nan Na'
r rtnrtgagee a mntaa sener
-o �- a�{- �00 -004. 7,�lS- O a- o �
ge/ Conbaa irde6teEness unpai0 as N Mortga9e / CanTact "uWebtetlness
Me 1, airtent yeer � date af appGcation
or wntraG se�er (number and stree4 �y. sm1e, eM 21P mCe)
ti�
Name ot assip�ea v dhu owner w hol0er ot mortgage
Pdtlress ot assignee (number aM atrae4 �Y, s+efe, eM
Ooes epptimnt own property in any aher
countymind'ena? � �,�_ n..Nn .
If awnaE wiN swneane dher Vun spouse.
Dr�umon apprwed in Cre amou• � t7.%�j 1� ��/'�' I/�
20
Sgrewe w Camry Aue',
�
I I We certfy uMer
ownerlcontractbu
�B�{��
�
ull resitlen� aEdrea W :
����
Person auUnraetl Ey du
P R ��°a���
Caunry Recordu
AUDITOR
as d Is Ne appOmnt Me sde
legal w equitade ame/7
n Yes n No
Is �he property in question: Mnuelly AssesseE
�2eai ProPertY ❑ MnuallY Asesud
T n�oeae ria,�e nc �
Has Na deduAm Deen requesleE m property
for artent Yea�? ❑ Yes
❑ No
� ��b�� r p_ p_ �
_ 1EUi'hiL �-
D� o� c,�w,m. e�Y reao
enalry of perjury that the�,��/`'ve anC foregoing intortnauwi �a v�� and cortect arW that the applirant is a resident of IrWiana arM
ot ihe a(orementioned proaerty on date applica4on is filed.
I � _ ,-. Date �nmM, daY. Yae�
De�
sta[e,
m
sbeet �y. sb(e. antl Z!P mtle)
�� �,�,,. �,:,��