HomeMy WebLinkAboutMortgage_Woolems (2) ate" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN s rip,O Township Year
71 4 FOR DEDUCTION FROM ASSESSED VALUATION
i' State Fom143709(R12/6-14)
a Prescribed by Department of Local Government Finance
INSTRUCTIONS: APR 2 4 2015 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 which the deduction��' ought. r�
Must be filed or postmarked with the County Auditor or County Recorder of the county w s y��i�ylCounty Auditor
located on or before January 5 of the immediately succeeding calendar year. f.I qq��ff��TTI++����'"` f1ITOR `—' County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the�dg dactQ6}I111��d��11p
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 restriction on never side)
■ JJ/10.(lto o? /A
Taxing Distri t Key number/legal description Record number Page number
/Aont _I—.) 26 - 9 -/S- 1/430V- coo 7r F. - Q aa
6 /dr /04
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,anent year March 1,current year date of application legal or equitable owner?
7�
/0 3 5 7 ❑ 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
eal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or coo,ottGad2Ft seller
/ s .
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any 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? ❑
11) 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 arty.hnmassimitv-rne,nfr•neiif rw,.+rded In,the county recorder's office)that is the basis for the deduction.
- R
Deduction approved in the amoi - '1
20 r Drawer NO I 20 20 20
Signature of County Auditor ` Date(month,day,year)
Card NO. ...,: 7 1U&:.•
II We certify under the pi • true and correct and that the applicant is a resident of Indiana and
owner l contract buyer of,...,,....._..._..__..__, _
Signature(owner's full name Date(month,day,year)
Full resident address of applicant(number and street,city,state,and ZIP m ) / q�
0703 s J ti we it o /l o1y�, I'76Y8-
Person authorized by duly executed Power of Attomey 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.
— r