HomeMy WebLinkAboutMortgage_McConnell zY 4\\' STATEMENT OF MORTGAGE OR CONTRACT E95 County Township Year
.�*a: FOR DEDUCTION FROM ASSESSED VALUA NN Y
State Form 43709(R12/6-14)
•' Prescribed by Department of Local Government Finance 11� O 6 2015
INSTRUCTIONS: J� File Mark
To be fled in person or by mail. aj Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for whi.'' he'.,, t'f?1 s t1�JJ�� cc��
Must be filed or postmarked with the County Auditor or County Recorde 41•+' ✓. y• t Q�Apmperty is ter County Auditor
located on or before January 5 of the immediately succeeding calenj�•r[c$r.CC b County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:M1FWI/d with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought. - --
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer restrictions on rave/ elT u , j
�6/'1/J e
TM District Key number/legal description Record number Page number
on 2 — /-/ 7-'l�a� (/ 59804 / 07
Record
x496
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 legal or equitable owner?
❑ 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 �s tth property in question:Annually Assessed
eal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
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 O
Drawer NO.. j///'
Address of assignee(number and sheet,city,state,and ZIP code)
Card NO. q//
Does applicant own property in any If yes,what county? What Taxing Di, \Y ite amount of deduction
other county 7,,
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance o s recorded in the county
recorder's office(including any home equity line of credit that is recorded in duction.
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.
Si natur (owners full name)e),n//n Date(month,day,year)
Si
l�
Full resident address of applicant(number and street,city,state,and code)
int S.D�e( f .Rd iS 2/N72.7
Person authorized by duly executed Power of Attorney or by IC 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 line not to exceed 510,000. -