HomeMy WebLinkAboutMortgage_Hill (7) } .7-4, STATEMENT OF MORTGAGE OR CONT� E 'NESS County Township Year
FOR DEDUCTION FROM ASSESSED V A I N
r • State Form 43709 R12/6-14)
C--4„,----, Prescribed by Department of Local Government Finance --
INSTRUCTIONS: AUG 1 3 2015 File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar ii r for wh' h th i deduction is sought.
Must be filed or postmarked with the County Auditor or Cou r /':r. -,; r: county where the property is LR County Auditor
located on or before January 5 of the immediately s t ';yrii ." !LLJ,
2) Mobile/Manufactured Homes not assessed as Real�Properfy: r p.- R'thYRJ&Auditor of the county County Recorder
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 qualification*.
Applicant(owner or tra t buyer-see restrictions on v sid
Taxis trio Key num /I al description Record number Pa a number
D _II-43-aoY--oo3�c0a-oaa Record , 529
Assessed valued 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,wnent 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: Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
DaCCI\\ //�� Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller y ' / ^•Address of mortgagee or contract seller(number and stree street,city,state,and ZIP coddde`)/,('n{'.1(V/
Name of assignee or other owner or holder of mortgage
(( Il CI4rYIe3 A
Address of assignee(number and street,city,state,and ZIP code) Old `lam
Does applicant own property in any If yes.what county? What Taxing Disuct? V I�--C 1 otAtoi m
other county ❑Yes ❑No )-°k 5 —33-1'1
in Indiana? �7 ��
A person is not entitled to this deduction unless the person has a balance on the perst %.. c'3_ 15 —FF I/ 0� runty
recorder's office(including any home equity line of credit that is recorded in the count) 1�.J
COUNTY AUDITOR .
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of Count'Auditor County Date(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.
&de re(owners me) Date(m r ,day,yea
4, --..._ ) ii1. /3-
nf O o f 1 app�Wt(n nd s t,city. te,and /P ) �r^ 47�Y/( of
P n authorized by duly executed Power Attorney or by 6 .1-12 .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.