HomeMy WebLinkAboutMortgage_Flaningan STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County I Township I Year I
(V4 FOR DEDUCTION FROM ASSESSED VALUATION
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Form 63709(R 12/6-14) I
Prescribed by Department of Local Government Finance
INSTRUCTIONS: J
To be filed in person or by mail. Fnor:je c w'Ath:
Filing Dares: 1) .Real Property:Must ce completed and dated in the calendar year for which the deduction is sought. NOV o- n�Must be fi led or postmarked with the County Auditor or County Recorder of the county where the property is vUr�ry Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ ounty Recorder
2) Mobile/Manufactured -icmes not assessed as Real Property:Must,ile with the County Auditor of the cc •^where the property is located during the hwelve(12)months before March 31 of each year She ded S See reverse side for additional instructions and qualifications. �� VN COUNTUD1T R
=per° n,.{a .(owner cr contra::airier see:= pson reverse 0
axing tic, Key rum legal de lc�' nil�O�r ���- ,3 f a. l✓fc 6 1 Record-anther Page number •
Assessed vallueeo1f real:roper,/as of Mortgage/Contract'v,decteoness unpaid as of Mortgage/Contract incebtedness unpaid as of Is the applicant the sole
Macon 1,current year - Marco 1,current year date of application legal or equitable carer?
Z(o y70O '-`t Yes i I No-
If no,wnat is his/net exam snare of interest? If owned with someone other than spouse,indicate with whom
If name on record is cieerent than that of applicant,indicate below: Is the property in question:Annually Assessec
,,Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact s 'ler
(r)VI r�ona. nK
Actress of mortgagee or contract seller(number and street,dry,stare,and ZIP code)
Name of assignee or other owner or holder of mortgage
Morass of assignee(number and street,shy,state,and ZIP cote)
Does applicant own property in any If yes,wnat county? b`:hat Taxing District? Has this deduction been requested If yes,state n.
te amount of oecuctic
other county I on progeny for
in Inciana? U II Yes a'No current year? Li l 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.
I COUNTY AUDITOR
Deduction approver in the amount of:
20 I 20_ I 20 I 20 I 20 I 20 I 20
Signature of County Aucitor I 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.
Signs,•re1owne s full am,e1 Date(month day,year)
�. +�-.�uu.3,Al, f(QQfu IO.; -ZDI4
FWI resident drones f applic (SFier and tint, state,and tiP code)
�?) � � !+ j �rinn�lor' f J 4-7 coo
Person authorized by culy executed Pow_t ct"AGdmey or by IC 6-1.1-12-0.7 Date(month.day,year)
ly
:dress of authorized person (number and street,city,state,and ZIP code)
I„
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.