HomeMy WebLinkAboutMortgage_Moye <}a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
''.....1% FOR DEDUCTION FROM ASSESSED VALUATION
`�-.)=- I`?+` State Form 43709(R12/6-14)
' ;%, Prescribed by Department of Local Government Finance
ILE .
INSTRUCTIONS:
To be filed in person or by mail. AUG For�fiJpp y'ith:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. L,L..2 J� Cll l�
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. C tt gecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the count
where the property is located during the twelve(12)months before March 31 of each year the deductifit18 11COUNTY A
See reverse side for additional instructions and qualifications. AUDITOR
Appli =nt owner. .. tract buyer
restrictions on reverse side)
T.:/f,�,/pis f / Key number legal descri� '^'� Reny nu err Pa a number
Vi �/ 4 , d - A 3 - I6, - .2 oo - 0oa • 6, 7S- o � y ! ? S 3
value of 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?
. . a,coo ❑ 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 Ac pcsed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortga ee or seller
A ■ i6
Address of mortgagee or contract seller(number an street,city,state,and ZI ode) - —-
Name of assignee or other owner or holder of mortgage "�CQ) ��_
�?CYXJ.O° ��Z _
Address of assignee(number and street,city,state,and ZIP code) Dr
'I've'. NO GO/5
Does applicant own property in any If yes,what county? What Taxing District? !� /7 •'''
other county Ca Yu IN o (X 5 93
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage u, •"• •••....., inty
recorder's office(including any home equity line of credit that is recorded in the county recorder's once)that is the uao._.
COUNTY AUDITOR .
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County yAuditor / "''.��'"L County Date(month,day,year)
I/We certify under the penalty of perjury that tf��d 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.
Si1g1`"-{af��ereM((oCwwn,,�j"ss fir0 name)/R y(��/J� ff Date(month,day,year)
u0 resident address of. pGC number and ree state,and ZIP code)
'C'I it a 5 E. unto In_ S s W./AA/ x-17(4 F MN) ■-r I m 3 9'
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 S10,000.