HomeMy WebLinkAboutMortgage_Bryant (2) n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.j4'. ¢ FOR DEDUCTION FROM ASSESSED VALUATION
;, -, State Form 43709(R12/6-14) r D•�� , Prescribed by Department of Local Government Finance �-'1 I L ' p k
INSTRUCTIONS: 11 �1 111JJJ File Math
To be filed in person or by mail. II''II II Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which thneduttiOn rght.
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. 2 .LFJI County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file wi , v f `2ifl;l ji r of the county
where the property is located during the twelve(12)months before Ms/) 1.s 41.r•(. `-a ,•1- • uctionii sought.
See reverse side//////for,,,,,,additional instructions and qualifications. �I TT VV
Applicant(owner fit tbuyer-se:res ' 'o•.on revers si ]
T ag ct Ke number/legal description Re dnum P
Cc� 02 -19 -(8,3o a-000.3 0 -oar ;/ V
va a of real property as of Mortgag tact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year Mardc i�1 ff��r--�� date of application legal or equitable owner?
`(((fffg0 ❑ Yes ❑ No
If no,what is his I 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 contract seller /may/// `k s ,//) `\'/�,� _ - /W Lam+'
•
Address of mortgagee or contract seller(number and street,city, and ZIP code)
►C'/i`Q']",�/-'-I[
Name of a
Drawer \O.- V015
Address a (Q�
Does appli `� it Taxing District? Has this deduction been requested If yes,state amount of deduction
Card \O.
other coup �11{��, on property for
in Indiana? `it'f 15/owe current year? ❑Yes ❑No
A person h '+r >alance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's .corded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR •
Deduction approved in the amount of:
20 20 20 20 I2//0 I 20 20
Signature of u Audi•oi-A}}`.' ' • L� County i/ �1(% y� ^^ ate(month,day,year)
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.
grature(owner's full name) Date(month,day,year)
ms_
ull resident address of applicant(number and street,a ate,and ZIP.••e_) i
a ID . R _)J ... .. Ik) 11710415
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$10,000.