HomeMy WebLinkAboutMortgage_Bowers ^^, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CoDl11 Township Year
b,_, '■ FOR DEDUCTION FROM ASSESSED VALUATION 1����/,
' � State Form 43709(R12/6114) 4®
,e Prescribed by Department of Local Government Finance
INSTRUCTIONS:
person or by mail. 9- O% ` W File Mark
*� Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction ha sought.
Must be Fled or postmarked with the County Auditor or County Recorder of the county where the prop;r. .•<i _County Auditor
located on or before January 5 of the immediately succeeding calendar year. .. � CS Cl�
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Au.i _i-L"1.. only County Recorder
where the property is located during the twelve(12)months before March 31 of each year th-a-. e. is sought.
See reverse side for additional instructions and qualifications. G\0
Applicant o erer or contract buyer r-se restrictions verse side)
T • District Key number/ gal description Record number Page number
ed value of real property as of Mortgage/ ntract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Ma 1,current year curr ye ov date of application legal or equitable owner?
❑ 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
Leal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortsag ee or contract seller
J72_IS.rd.!v rt D
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 1 - ----
Name of assignee or other owner or holder of mortgage Qo uStC'S s,
r"4-0.9 ��k
Address of assignee(number and street,city,state,and ZIP code) '�1 111'C 1 O
3—a-a1:3 \S
Does applicant own property in any If yes,what county? What Taxing District? I Card O �U -‘1'n ion
other county ❑No r `03 1 (0 O O
in Indiana? Dyes
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract inoeotecness roar is recururru H,o.o 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/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( me full name) ^ /a Date(month,day,year)
Full resident ress of of appl p�umber and street,city,state,and ZIP code)
JC 4q a,1 E rtSo s 1444.41017t dt TJ 4'7 .5?
Person authorized by duty 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.