HomeMy WebLinkAboutMortgage_Algaier inn• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
1 N ; FOR DEDUCTION FROM ASSESSED VALUATION
'1'4 State Form 43709(R12/6-14) '
e Prescribed by Department of Local Government Finance
Fll elar�
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INSTRUCTIONS:
To be filed in person or by mail. Form ft ed ED
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 4Coup/t/y]IA{uditor
located on or before January 5 of the immediately succeeding calendar year. LI Counly4lecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction ugh ' , -
See reverse side f ditional instructions and qtr{@lifica6ons. l eSON CO v r”fti
Applicant(owner. Tract buy - ee restriction /
onSversg5ry) uN IY,q
OR
Taxi n .'G ber gal deessvippttio Record number Page number
/ ofu�- /8_ 4 /-ooa. 677- oaft d /r 3546
- .,a of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtydness unpaid as of Is the applicant the sole
March 1,current year March 1,anent year date of apple / /, legal or equitable owner?
L/��d(,/ ❑ 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 property in question:Annually Assessed
Real Property ❑ Annualy Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller `/ryJ�i _ Ol /4 Al r
Address of mortgagee or contract seller(number nd street,city,state,an ZIP code)�`lll] !/ Ili ' j
Name of assignee or other owner or holder of mortgage / l)
Address of assignee(number and Street,city:state,and ZIP code) / U�
_ �'n1� a�
Does applica —'--'-any If yes,what county? What Taxing District? Has this dedu '• ^-n requ If yes,state amours of died -on
other county - - __ on property for
N Indiana? S�� /r�11 II - - current year? Lr es No•
A person is r`1 E �N6_ ry l E le r• n the person's mortgage or contract indebtedness that is recorded in the county
recorder's t 2S C 1si Si if,. —' ° the county recorder's office)that is the basis for the deduction.
t' v ....."(--e. I
a 11SO fJ t- 1)-(9`'�`^`itt V,j LTC)NTY AUDITOR -
Deduction: �{
20 a01 J_ 0 O 0 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the penally of perjury that the above 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.
Signal (owners name) it/ Date(month,day,year)
. et is Full resident addre of applicant(number and s-.t,city,state,and ZI e)
816,x. JrL,� �. 764
Person au owned by duly exe•. ed Power of Attorney or by IC&1.7-12-0.7 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 570,000.