HomeMy WebLinkAboutMortgage_Delong (6) nq STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
.� FOR DEDUCTION FROM ASSESSED VALUATION g-1 I L gF
l5 ° State Form 43709(R12/6-14) 1 �iI
B;-,-,ii, Prescribed by Department of Local Government Finance
INSTRUCTIONS: JUN 1 1 File Mark
To be filed in person or by mail. JUf v 6. 41 4 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 Recorder of the county where the prope. 's , , 11 Cou r ty Auditor
located on or before January 5 of the immediately succeeding calendar year. .. ruin County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County AuditgigeeFftetink T
where the property is located during (f-twelve(12)months before March 31 of each year the deduction is soug - -
See reverse/for additional instructions and qu. at ions.
Applicant er or contnUb er-.e res ens• es/de)
/ I
I a. '9 411 A �,id�/ a
axi ict / Key n ber/legal des lion ir Record number Pa e numbe
i7� r 0— Y.-/c/--Q50/- 067 /ag a? 6 WDtS 1e3'/7
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 1,current year date of ❑application�/ lea) legal or equitable owner?
Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other DIM spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
eat Property ❑ Annually Assessed
A/// Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller Caec �/�'/,4�/�Address of mortgagee or contract seller and ity,stet ,and ZIP code)
Name of assignee or other owner or holder of mortgage �l
Address of assignee(number and street,city,state,and ZIP code) //aatitiz97c.r...Does applicant own property in any If yes,what county? What Taxing District? Ha'\s(/this deduction been requested If yes,state amount of deduction
other county —I on property for
in Indiana?_❑Yes. ❑No current year? ❑Yes ❑No
A persc- ----- r a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorde s recorded in the county recorder's office)that is the basis for the deduction.
o( COUNTY AUDITOR
Deduct: Drawer NO
2( Cat-� \O. ( `' 20 20 20 20
Signatu County Date(month,day,year)
•
I/N ..,_ _, ..._ ___,....,...d foregoing information is true and correct and that the applicant is a resident of Indiana and
own contract buyer of the fore - tione. 'roperty on date application is filed.
Signet owner's full name) �/ ' Date(month,day,year)
hn'�r�app
r`rLi resident address o applicant(number and-reef, ty,state,and IP code) ^
5mE5bc%%l . SY-r tatt end 1.N Lr7cYR
Person authorized by duly executed Power of Attorney or by IC 6 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.