HomeMy WebLinkAboutMortgage_Jones (14) t°. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION $ vvv
State Form 43709 partme14),; Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. SEP 4 2015 Form filed with:
Filing Dates: 1) 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 property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. �I County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CountyAud e(` 'Ci��1
where the property is located during the twelve(12)months before March 31 of each ICI$BSECiNdeogorinseupto DI OR
See reverse side for additional instructions and qualifications.
leant(owner or contract buyer-see restrictions on reverse side)
T ing Disuict / Key number/legal desdription Record number Page number
atp /7 - ao - yoo - ono. 3 v0 oA/ ao ( 3 ?-0-1
Assessed value''r e a l. ..- ..of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Marc,1,conen ear March 1,current year date of application legal or equitable owner?
81 doo ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other the/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 61.1-7)
Name of mortgagee or contact seller Vie'e Chi Lt,de—1 D — )14.c.d 01/v+4- vt' '
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Add ss of assignee(number and street,city,state,and ZIP code) - - - - -.
VT P ihi 51' ,t o 3 / )_ SA- c �' �'�. 100
Does applicant own property in any If yes,what county? What Taxing District? Has I
other county on pi
in Indiana?is ❑Yes ❑No come . /p--
A person is not entitled to this deduction unless the person has a balance on the person's coo Drawer NO. l/,/)//....\f
recorder's office(including any home equity line of credit that is recorded in the county record
COUNTY AUDITOR 59/ (/ _
Deduction approved in the amount of: Card �1 O. ..
20 20 20 20 20 20 20
Signet reditor \ County Date(month,day,year)
I I We certify under the penalty of perjury that the abtSve and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signatur (owner's foil name) 0 Date(month,day,year)
Full resident address of applicant(number a and street,flfy,state,and ZIP code)
/(f Sa08 S 11 00 LU Utueosii lie .-4J. y7lp10S
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 510,000.