HomeMy WebLinkAboutMortgage_Arnett • .4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
sib,-,_ 's FOR DEDUCTION FROM ASSESSED VALUATION $yry
p State Form 43709(R1216-14) S
+�-, Prescribed by Department of Local Government Finance
f
INSTRUCTIONS: 4 File Mark
To be filed in person or by mail. JUN 4 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 tiled or postmarked with the County Auditor or County Recorder of the aunty w�-re ... . .perry is County Auditor
located on or before January 5 of the immediately succeeding calendar year. !�ri�ir,11ipt County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with t 'r':.•
Y�1+'.t nty
where the property is located during the twelve(12)months before Mar 9:OS&•• e e uction is sought.
See reverse side for additional instructions and qualifications.
Appli t caner or contract buyer-see resbicti s on r verse side)
C � 'V Ord/
Taxing District Key number/legal de tan Record number Page number
a€, -/9- / 303 000 i/ac3 co ,o/g' 424---b
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contrac indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
?Selig . ❑ Yes 0 N
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)
Nameof mortgagee or contract sell ' _
oral/mnrn —
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) /n/ 7/r./�/!,/,/l- - ___
Name of assignee or other owner or holder of mortgage (�✓ V - " '.�/(/�15,(J1��(YJ/�-G�Ir��/ / Q
Address of assignee(number and street,city,state,and ZIP code) !
Does applicant own property in any If yes,what county? What Taxing D i5- d a5(6 ate amount of deduction
other county
in Indiana? ❑Yes ❑No
. A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebteaness ovar is recorded in the county
recorder's office(including any home equity line of credit 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 County Date(month,day,year)
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.
Signatur .w•- ulln e Date(month,day,year)
if
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Fux[--ide a•dress of Gwnt(num rand street,city,state,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 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.