HomeMy WebLinkAboutMortgage_Gayso } STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�' FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(RI a f 10-15)
Presorted by Department of Local Government Finance
INSTRUCTIONS: Ar F
Tb be filed in person or by mail. �v 6, Fonn Medwa l'.
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county whertjp a pro y- i is 4;County Auditor
located on or before January 5 of the immediately succeeding calendar year. 3 V/,
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor otk go,- ,:� � County Recorder
where the properly is located during the twelve(12)months before March 31 of each year the deduction is :I1 Vii;`
See reverse side for additional instructions and qualifications. 1-
4.1 1,..
' wwamtaabuyer see on side) .,j0
j ca•
Key number I legal description Record ny�Cer
,Q - ee t o oZo ' /-0 7 or 00-000. '5<?a-Oct 7 .�0/ o7S`�
-.vakie of nil pmpestr as of Mortgage 1 Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year data of appfretion legal or equitable owner?
❑ Yes ❑ No
If rio,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on retards different than that of applicant'indicate below. Lfisle property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home PC 61.1-7)
Name of mortgagee or contract seller /42.} ,
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(nu d street ' ,state. e)
Does county own property i If yes,what county? What Taxing District? on Has this deduclion
for been requested If yes,state amount of deduction
other in Indiana? ❑Yes No ahrrent year? ❑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 aedit 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 20 20 20 20
Signature of County Auditor I County _. __ I Date(month,day,year)
14,' act- iy
I/We certify under the penalty of perjury that the above and foregoing inform thane and
owner l co. ,-. - buyer of the aforementioned property on date application is t Drawer NrO.
Si rhatur- .•
8 Cline
F -14-raappnumber and street city.state,and LP code) Card NO.
5o3a ) SQCPy ( r7IA cf.Q�er-. �,Vv ti74
Person authorized by duly executed of Attorney or by IC 61.1-12-0.7
I
Address of authorized person (number and street city,state,and ZIP code)
•
The penalties for perjury can include imprisonment up to two and a hat years and a fine not to exceed$10,000. - - -
^^Q.q STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township ' Year
FOR DEDUCTION FROM ASSESSED VALUATION
�' State Form 4by D(parment) 1 .H_ I 1La
,i�'�' Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. AA�,I//.1yy ,,(( 99� Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year folltI?X h The dddlr on is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Auditor
located on or before January 5 of the immediately succeeding catend year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Mus yAuditor of the county
where the property is located dudng the twelve(12)months l3(8$Ettlt9 Riffily6tction is sought.
See reverse side for additional instructions and qualifications.
S ct buyerA see rpstricti on reverse sid
�.i Key numb r/legal dRecord numher Page numher
&b-I I-0 7 -c1Q7 -�Op.y �7 ap (�F S 9S7
Assessed value of real prope 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?
35000 ❑ 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 properly in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller AA\haft
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 applica --A-°—"-T°°1 g District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? current year? ❑Yes ❑No
A person is / :e on the person's mortgage or contract indebtedness that is recorded in the county
recorder's c Drawer NO I l / din the county recorder's office)that is the basis for the deduction.
1T OUNTY AUDITOR
Deduction a (�
Card NO. ...-.1••5.771-:
20 20 20 20 20
I
Signature of my Auditor / f County Date(month,day,year)
I e 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 co t buyer of the y7forementioned property on date application is filed.
Signature net' fulleames Date(month,day,year)-
ull r s5n(dress of appWwni(number an stye(t,city tate,and ZIP rode)
3a `� s ��the�J�U. �1 �l o
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$10,000.