HomeMy WebLinkAboutMortgage_Doyle (4) tan, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
1 °�- -{ FOR DEDUCTION FROM ASSESSED VALUATION
_tt State Form 43709(R1216-14)
F . L,E
-„� ` r' Prescribed by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mail. orb with:
Filing Dates: 1) Real Properly:Must be completed and dated in the calendar year for which the deduction is sought. JUL 1 fi C u I
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. . 4.- Is:. • -ecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the co. 1'11,
where the properly is located during the twelve(12)months before March 31 of each year the dedu r . ,. �2R A
See reverse side for additional instructions and qualifications.
� � •UNTYUDITOR
Applicant(owner or contract buyer-see -sMctions on reverse 'de)
Ate L _ Z 2 , , ,ice
T-V.istrict Key number/legal desmptip Record number Page number
11.X. SC ivd C24 -/a- o7 - /0.3 - 000, 399 -a .t8 IS /�jcPa'
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,anent year March 1,current year date of application � legal or equitable owner?
44 3o0 C) ❑ 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 contact seller �, � � �4�,,�
Address of mortgagee or contract seller(number and and street,/c-'c-s city,state,and ZIP code (�1r1(� ///l/�� y/�ry1) o I _�
Name of assignee or other owner or holder of mortgage J ' - r `fir l�lk. fl,U,
Address of assignee(number and s I,city,state,end ZIP�yde, //UUII /5-- 1158
Does applicant own prooppeerty in any If yes, t county? What Taxing District? I iuction
other county r
in Indiana? ❑Yes ❑No ,
A person is not entitled to this deduction unless the person has a balance on the person's r„,.,,u,.y_ _. 1e county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis roc uro __
COUNTY AUDITOR .
Deduction approved in the amount of:
20 20 20 20 20 20 20
t
Signature of County Auditor County Date(month,day,year)
I II I We under the penalty 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.
ignat fW name) Date(month,day,year)
i0\4".fre 0 resident address of applicant(number street,city,state,and ZIP code)
LQO3 W. [mcrsrtfl 53. rPrirlorton .TN `17(070
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 S10,000.