HomeMy WebLinkAboutMortgage_Hensley (3) ,e:-.%"1--9._
FOR DEDUCTION FROM ASSESSED VALUATION INDEBTEDNESS Cot Township I Year
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.-, State Form 43709(R12/6-14)
°``;;; ? Prescribed by Department of Local Government Finance
INSTRUCTIONS: JUL File Mark
To be filed in person or by mail. 1 r o Ark}•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 ❑ •suety Auditor
located on or before January 5 of the immediately succeeding calendar year. '' ' w•�nrfi j; ounty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County AuditorQilfl3SQ{41�oUNI
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.
Appecant(wn- or••ntract byyer-see;irons erne side)
axi • District Key umber I legal descri tan Record number Page n er
i 4 h 6 -/a/6-/a/- 4o/ /�7- cal 2 0/C of6 a
Assessed value of real as Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedne unpaid as of Is the applicant the sole
March 1,arrest y March 1,current year date of apWcation legal or equitable owner?
• /o d(�p)� 0 Yes 0 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 R propery in question:Annually Assessed
Real Properly ❑ Annualy Assessed
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Name of mortgagee or contact seller/ / / - —
i
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
ZJA,A074 ,4 ,_z -
Address of assignee(number and street,city,state,and ZIP code) /j
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Does applicant own property in any If yes,what aunty? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county - on property for
in Indiana? ❑Yes ❑No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's ofr�ce_(includinng any home eeqquiitty_line_ojf credit that is recorded in the county recorder's office)that is the basis for the deduction.
I�y n M [.�Yf 1„/ I ' a.A. t �i• COUNTY AUDITOR .
Ded -�rx'�� (
02D D 1s-01(/
080 _ 20 20 20 20
Sign County Date(month,day,year)
I. , _..__. _._r_.....-, _.,,.,.,,.,, ,,.o•,,,o a•....e 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.
Lure(owns itll n e) Date(month,day,year)
Full resident address of/a�ppplica umber/ay�nd street,`city,state, nA 11 P cod ) b
2.I v1/ �r sQ 07 t AiACtiW/I �Iv �(67�0
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 510,000.