HomeMy WebLinkAboutMortgage_Wilson a° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
>` Stara Form 43709(R12/E14) •
r ;-r; ' Prescribed by Department of Local Government Finance "LED
INSTRUCTIONS: ark
To be filed in person or by mail. f -- 1 1j
Filing Dates: 1) Real Properly: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 property is ❑ Coun Auditor
located on or before January 5 of the immediately succeeding calendar year. (: ' y/•N)�? Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of thd'c1 N C u r
ere the property is located during th twelve(12)months before March 31 of each year the deduction is sought. ' • . s R
See reverse s'ie or additional instructions and qualif ations.
Appli.'nt(. • orlcoi .ctb > -see ns on erse side) �
lb 6 • ir t§ar' v l
taxi •Dis c. Key n /lega d ption Record number Page number/
of ( - / - - 6 3- 6 )/. Oao 4 (/��yo/s- d �a
Assessed value of real property as of Mortgage/Contract inde tedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant e sole
March 1,current year March 1,Current year date of application r// ado , legal or equitable owner?
•.! o ❑ 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 th property in question:Annually Assessed
Real Property ❑ Annualy Assessed
/ /,���� Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller an city, /
Address of mortgagee or contract seller(number an t,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
/U
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state a nt of ded lion
other county on property for
in Indiana? ,❑YPC—❑No _ current year? ❑Yes ❑No
A person is not - -"e person's mortgage or contract indebtedness that is recorded in the county
recorder's offic 4 solo?9- 00 county recorder's office)that is the basis for the deduction.
'AUDITOR .
Deduction appr OI G •
Dra14Lr NO `J
20 r 20 20 20—
Signature of C. �"a 1 N O• I County Date(month,day,year)
I 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.
Siig/'[',3�/�'re owner's full
l,name) -�^o���.,'' Date(month,day,year)
T
Full resident address of applicant(number and street,city,state,and ZIP code) J
I X /lr g en 5 // J o /_ Q ,f,-r/4 n/ U 62 / I`� / is ill /7
Io 6 6
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. - -