HomeMy WebLinkAboutMortgage_Conner (2) »^'r. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township I Year
, '4 FOR DEDUCTION FROM ASSESSED VALUATION I
e ' State Form 43709(R12/6-14) ; .
-,,;r Prescribed by Department of Local Government Finance .•-• : i E me
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INSTRUCTIONS: 'P'r
To be filed in person or by mail. Form filed with:
Filing Dates: 7) Real Property Must be completed and dated in the calendar year for which the deduction is sought AUG O vvHf1
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is G ,. 4Sl I4ounty 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 sit nty,
where the property is located during the twelve(12)months before March 31 of each year the deduct'. t,�.;;.--, ,j
See reverse side for additional instructions and qualifications. G19 r��1A'
Applicant(owner or con act buyer-see restrictions on reverse side) SON CQ�Nry AtID1TOR
Sri an V . Canner- cf- uesstco L . - Cohrtt----
Taxing District • Key number/legal description Record number Pa a numb r
cLvuarny )4-H -a-i-acx-vo?.r5 035 NE V+ NE (iy air 3-i0 ��l 0
Assessed value of real progeny as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1 y ar o O March 1.current year date of ap2fr5 . COO legal or equitable O
a/fn.
IF r/es No
If no,what is his/her exact share of interest? If awned with someone othr than spouse,indicate with whom
1 If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
[f..Rial Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Nagrect mortgagee or contract seller �j
etnnar i' � 12-I'tCG/in C7urp
IAddress of mortgagee or c4seller(number and street.cCy state,and ZI e 7/�-x
II i , St' Jasp/ Yb'/
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Dces applicant own property in a If yes.what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? Yes No current year?
Elves
Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 I 20 20 20_ 20
Signature of County Auditor County Date(month,day,year)
I 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 I contract buyer of the aforementioned property on date application is filed.
m .-�' t (o .'s full name) Dateg}h day,year)
C, >r��� / �aix>4/l a/ad,i�O/T
Full resident of a plicant(nut and t city,sta acrd ZIP codel r r ) �^6, 7 k
X371 f "LSD 3 -i2 {Tn ' /
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 sneer,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.