HomeMy WebLinkAboutMortgage_Tedrow (2) .b,• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALr1 E D
Vt ' State Form 43709(R12/6-14)
<- Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. MAY 28 2015 Form filed with:
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 Re •er oft - . . --re the property is County Auditor
located on or before January 5 of the immediately succeeding ca: --writ
2) Mobile/Manufactured Homes not assessed as Real Progg R�I'i y'il; .. r#tor of the county County Recorder
where the property is located during the twelve(12)montf&�-'.1" k• 'r • -a 0 -- t e deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or co ract uyer- res " nsc verse Fpe)
T isMCt Key nu er/legal description Record number Page number
‘ JAii1tCk �Ot� (0—/d-07400, -00/• /S/oa8 ao/S 98 1
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,current year March nest year date of application legal or equitable owner?
60 (p 000 ❑ 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
❑ Real Property ❑ Annually Assessed
. Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 5
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 strew'-^`--- ZIP code)
AOI 5•••"•• ? What Taxing District? Has this deduction been requested If yes,state amount of deduction
an property for ❑No
D rayf er ��� current year? ❑Yes
Jerson has a balance on the person's mortgage or contract indebtedness that is recorded in the county
1 -edit that is recorded in the county recorder's office)that is the basis for the deduction.
Card NO. ..........d3
/ COUNTY AUDITOR
D g O 1�2
CW
20 l 20 20 20 20 20 20
Sgnatur of Fount'Auditor , / County ��'"� Date(month.�e8 yea, _N
4 Cy✓LJk/ Y) hat the �a resident ri d
1/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 I contract buyer of the aforementioned property on date application is filed.
Sign (owner's full name) Date(month,day,year)
SL�d,�;t �'f�� Sag-/S
Full re ent address of app(s'�tit,(number and street,city,state,and ZIP code)
I° /1 S id, 4_x € xlt;t, Pit.v,Lcr, i_ T Al it 74,70
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$10,000.