HomeMy WebLinkAboutMortgage_Wallace �o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
I. .- State Form 43709(R12/6-14)
---, Prescribed by Department of Local Government Finance q� p
INSTRUCTIONS: L
To be filed in person or by mail. 1 f�r,�fded with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. MAY 1"1 CU IJ
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 calendar year. A, nty
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the •.�, ,Tiprm►t‘ n Recorder
where the property is located during the twelve(12)months before March 31 of each year the deenti, • •• ejtJNTY AUDITOR
See reverse side for additional instructie s and qualifications.
Appli w or contract buyer-see res "ctions on reve e side)
Oda/_L t �1 d r
T.xtn: G slot( Key tuber/legal de Ion Record number Page number
;ir to . ...//-/4 /0/- add. .5 4/- oa "7 016 /4- fag
Assessed value of real sooff/L,//) Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
a
Mardi 1,current year March 1,current year date of alication� legal or equitable owner?
/130p 34 p0 ❑ 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
4 lfC Real Property ❑ Mobile le o e(e Assessed
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 p a3
_. _- -
Address of assignee(r 3 Q�s- o
__ 0.w.�f O� Wo-`\-C-. �
Does applicant own pa t •••••••,.....• Has this deduction been requested If yes,state amount of deduction
other county ❑Ye DCa\1'Cl• ��• on property for
in Indiana? current year? ❑Yes ❑No
A person is not entitle Jerson's mortgage or contract indebtedness that is recorded in the county
recorder's office inch Card 1 'unty recorder's office)that is the basis for the deduction.
.,..Ury I r AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I 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.
.S. Signature nets full name) Date(month,day,year)
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Full resident addr- - of applim• (numbs and street city,star,., IP code)
CO c__, i . "it s _ C1 '
Person authorized by duly executed Power oomey 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.