HomeMy WebLinkAboutMortgage_Bolden "%-- STATEMENT OF MORTGAGE OR CONTRACT INu= 1 t.DN=SS I County I Township I year
'=C ;:... FOR D=RUCTION FROM AJJ=JJ_J VALUAT ION
7 -. FI
=s% State Form 43709(R12/5-tc)
\ Prescribed by Department of Local Government Finance
File Mark
/NSi,RUCTIONS:
Toberdedinpersonorbymail. -
MA Fe "Re S'15
Ring:Dates: 1) Real Property:Must be completed and dared 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 where the properly is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. �. •�.! e;• recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must foe with the County Auditor of the county 'PA)►hr
where the property is located during the weHe(12)months before Marl 31 of each year the deductip(y`►$$QN C i I 1 TY AUDITOR
See reverse side for additional instructions and qualifications.
ant(owner or dorrract bu s_e sr dons on reverse side)
. riS .T or n Z //
1 Taxing District coat'number/Ica!descripdoo -t-J10 Record number Prenumoer
�b 1i-118-lf03 600.307-067 rg„el M�nnthr6cb-)m /5 Jm
1?sa sled sa!u e of real pmpery zs a Morgage/Ct ntaro inde-'dness unpaid as of ongage/Conna:indebtedness unpaid as of Is thole
MaCt 1,wren:year Martn 1,curerr year daze of z C �dn I legal or equitable owner?) do
D Ards ❑ No
it no,what is his/net exact share of interest? If owned with someoa_other than spouse,Sidi:ate with who.-
If name on record is different than that of applicant,indicate below Is the property in question:Annually Assessed
. —eat Property ❑ Annually Assessed
• /� Mobile Hone(IC 6-1.1-7)
runt / a Of'/t ct s II /�1-W
Address of mortgagee or con t s r(number and street,ciy,state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage -
Address of assignee(number and street,city,sate,and ZIP code)
Does applicant own prose n in any If yes,what county? I What Taxing District? Has this deduction been requested if yes,state amount of deduction
other county e-/ on property, for
in Indiana? IJ Yes No curen:yea? IDYes I INo
A person is not entitled to thi deduction unless the person has a balance on the person's mortgage or contact indebtedness that is recorded in the county
office(including any home equity line of credit:hat is recorded in the county recorder's office)that is the basis for the deduction.
I _ COUNTY AUDITOR -
Deouction acproved in the amount of:
IJe
20 I 20_ I 20 I 20 I 20 I 20 I 20
Signature of Couny.Auditor I CounCounty th
Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and cored and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned prope try on date application is filed.
Signa: (owners full name) Date(month,day,yeah
9h i� &Qt 14/ -021— /5
cull resident addr ss o, liars;/{nu and street u 6 are,ens?F c ) /V q � �
/?(0 A• Qs/ d Sw) Da cod I. / .
I Person authorized by duly executed Powertf Attorney or by IC 5-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and:teat city,state,and ZIP code)
I^
The penalties for perjury can include imprisonment up to r.vo and a half years and a fine not to exceed$10,000.