HomeMy WebLinkAboutMortgage_Miller (17) g:fl STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
; fl_ % FOR DEDUCTION FROM ASSESSED VALUATION
" $5 !, State Form 43709(R12/6-14)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: FiIM is
To be filed in person or by mail. Form(ED
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. A
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is Rp E, ,a Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ Co Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduc6dw/ - i
See reve side for additional instructions and qualification. ��• CO/r V�. r.7
Applicant( wner orcont ct buyer-seem n'�Jionson rev see fde)) /�// /^/ N�y q
)/ P�/fed/ ti/ 7 //!/� } � C�cct j //7/ �OfToR
Tax' g strict• Ke number/legal description (/ Record number Page number
1114-04-16" -//-/o- /00- cbo. s9S4 oaf do ts i5Y3
Assessed value of real property as of I 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 a » n legal or equitable owner?
,/j cep ID yes ID No
If no,what is his/her exact share of interest? If owned with someone othdr than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: �,Iss.tthe property in question:Annually Assessed
Xrl Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
C/iee)e,1 : e /5i7/OT� y/'�
/
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 I If yes,state amount of deduction
other county on pro^^^•`^• _
in Indiana? ❑Yes ❑No I _curren
A person is not entitled to this deduction unless the person has a balance on the person's mon r
recorder's office(including any home equity line of credit that is recorded in the county records . .
4n' COUNTY AUDITOR 6;70 Deduction approved in the amoun(of: Drawer N /t)-
•.
20 20 20 20 Card N O. ... /61/3
Signature of County Auditor County
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.
1. Signature.(owner's rue name) �.y. /J�f Date(month,day,year)
�(. CO- rte! (.f'YFn
XFull resident address of applicant(number and street,city,state,and ZIP code)
(
OZ OS N, Yr/S f jiK° frpihce-ton 'AA<'AA Y 76 70
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$70,0170.