HomeMy WebLinkAboutMortgage_Wallace (2) •gin, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
a'\'. 'F FOR DEDUCTION FROM ASSESSED VALUATION
"f" State Form 43709(R12/6.14)
;e„ •' Prescribed by Department of Local Government Finance • _
- INSTRUCTIONS: I ?., File Mark
To be filed in person or by mail. F� Form filed with:
. Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the dg, o¢is swig
Must be filed or postmarked with the County Auditor or County Recorder of the od8 iawwert t petty is Dusty Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the ny Auditor of he ty
where the property is located during the twelve(12)months before March 31 of e r- on is sought. -
See reverse side for additional instructions and qualifications.
Applicant(own rc contract buyer-se rest' son eve side) CIBSON COUNTY AUDITOR
�� rest
Taxing District Key number/le I descri do Record number Page number
Qs° - -0altio-oo( •7co0-C a0/ S 3530
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,anent year March 1,w nt year date of application legal or equitable owner?
is CCO ❑ 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: 1 Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
unpile Home(IC 6-1_.1-7)
Name of mortgagee or contract seller n
L 1 aht-F/l, �O1S- 35 .8 0
Address of mortgagee or contract seller(number and stye ,city,state,and ZIP code) t�
I ,odo 1�n M. el. rlv,nol� M
Name of assignee or other owner or holder of mortgage W .--'\``(k-Q-e- $0 6 fil
Address of assignee(number and street,city,state,and ZIP code) - a\a \OO
Dees applicant own property in any If yes,what county? What Taxing District? Has this deduction I n
other county , property for G' a\-
in Indiana? Yes ❑No current year? I- 1
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or car my
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is we uaa,a _-
r
COUNTY AUDITOR .
Deduction approved in the amount of:
20 20 20 20 20 20 20
1
S'•,: - I County Auditor County Date(month,day,year)
. ! I • ('mil
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.
Si lure(owner' Date(month,day,year)
W . sides address of applicant(number and street,city,state,and ZIP code)
3 75-41 C. /On N R�nrce�v{v.r, /� Y76 X>
Person authorized by duly executed Power of Attomey 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 510,000.