HomeMy WebLinkAboutMortgage_Hartley (4) 7,9. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. 1.11 FOR DEDUCTION FROM ASSESSED VALUATION q®g�Jp/
`--:- :'4" Stale Form 43709(R12/6-14) � �� J J LJ
w= _1 Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. JUL 1 4 If hill filed with:
Filing Dates: I) 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 propel( is M Co sly Auditor
located on or before January 5 of the immediately succeeding calendar year. �r
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CountyAud tpl1. �2 :: gRlijp'� County Recorder
where the property is located during the twehre(12)months before March 31 of each year the dell.'.:. Q4 ..T. IN - - -
See reverse side for additional instructions and qualifications.
Applicant or con U buyer-see resbi s n reverse side)
�,,J f / �r,tG/�?-y/ ny�ger
Taxi is' Key nny mbar/�leJgal description i;�' ` Rewrd/n}lmber Page`/Y
ofla -/of-02-,/M-000, Oo?J� -„3�.a' :;bat)
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 0 legal or equitable owner?
‘2V/ °a ❑ 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 property in question:Annually Assessed
Real Property ❑ Annually AsePssed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /p
6�e / n
Address of mortgagee or contract seller(number and street,city,state,,aand ZIP code)
Name of assignee or other owner or holder of mortgage
o_pco (� //��..��
244- /66 ,44--
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own prooertyin any_j If yes,what county? I What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Y. -- current year? ❑Yes ❑No
A person is not entit �����````` Ah ryV n the person's - ounty
recorder's office(im I the county rec
1.1C7.,Lb-,--. 'ITY AUDITOR
Deduction approved i Etinatiku 1. _
. , le
20 arab)- t10-c01
____
/S”-dlo99-tie) woo ^6 -/ - 07_ /02 Goo, �Ss� -
Signature of County, /s 1(�()- 4J4 ITV% County v-�8
I/We certify under the penalty of perjury that the above and foregoing information is tru I and
owner/contract buyer of the aforementioned property on date application is filed. D 000
f Signature(owner's full na e) o�
y`fl,- Full resident address of applicant(nu bar and street,city,state,and ZIP code)
IT-
/2. 0 E. GJar�j1SI' riri crt'o, r, q- `7G
Person authorized by duly executed Power of At. mey or by IC 6-1.1-12-0.7
Aad"° /11lLa-
Address of authorized person (number end 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$10,000.