HomeMy WebLinkAboutMortgage_Smith (38) n STATEMENT OF MORTGAGE OR CONTRACT I TAD aunty Township Year
•b e., ' FOR DEDUCTION FROM ASSESSED VALUATI
' � State Form 43709(R12/6-14) AAAAAA
--, Prescribed by Department of Local Government Finance
INSTRUCTIONS:
APR 2 3 ZOS File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for whit a de sought.
Must be filed or postmarked with the County Auditor or County Recorder t6 erty is County Auditor
ca
loted on or before January 5 of the immediately succeeding calg@s?i(�� ps COU V U ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Mu3?'he 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.
Applicant(owner or contract buyer-see resbi d on reverse side)
S-?1,</ill
Tatertrict Key number/legal description // Record number Page number
ruin z 6-ia-iS-/o3 -co / 7.23 - 4c= 87 /Q . 555-5
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
//O CO° ❑ 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 •
al Property ❑ Annually Assessed
yyy Mobile Home(IC 6-1.1-7)
Name of mortgagee r coJr jract s le�
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage --_______
{.f�
Address of assignee(number and street,city,state,and ZIP code) % \Y,,/_Y(—,"'� L -_ —
Does county
own property in any If yes,what county? What Taxing District? /� luction
other county
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the per U he county
recorder's office(including any home equity line of credit that is recorded in the cow -/u_)- s5 8 5
COUNTY AU'
Deduction approved in the amount of:
20 20 _ 20 20 20 20 I 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/contract buyer of the aforementioned property on date application is filed.
Sjgnature(OwnuO Arre // Date(month,day,year)
Vielian 2.5) #4•1444
Full resident address of applicant(number and street,city,state,and ZIP code)
A /007 .Snfct 1 1 a// Street PrMre tom, r%) 47670
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.