HomeMy WebLinkAboutMortgage_Woolsey "w STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun fLWP Year
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a:,�-,•. FOR DEDUCTION FROM ASSESSED VALUATION -1
-.,-.1,,, N� State Form 43709(R12/6-14)
S j`'-'P Prescribed by Department of Local Government Finance •
INSTRUCTIONS: SEPF&MT1315
To be filed in person or by mail. 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 rope 0 S •r •uditor
located on or before January 5 of the immediately succeeding calendar year. �IBSON COU �A ecorder
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)mon efore March 31 of each year the deduction is sought.
See reverse sit for additional instructions and qualifications.
Applicant(o er.r contradb r- eere s verse side)._/.Y e (Xix io c) _0 00 As
T- • is Key number legal des6iption Record number Pa number
d�916-/3-/00 -00/. / 9- Q� 4a/ C 03/6
Assessed 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,arrent year date of application legal or equitable owner?
070 090 ❑ 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 t property in question:Annually Assessed
pfI Real Property ❑ Annually Assessed
///jjj ��1.�. _ A
\ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller '
. • .0 /!�A/O✓U'l
Address of mortgagee or contract seller(number and street,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)
Does applicant own property in any If yes,what county? What Taxing District? I Has this deduction been requested I If yes,state amount of deduction
other county - — - - --
❑
in Indiana? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the pet I county
recorder's office(including any home equity line of credit that is recorded in the coo /5- --
COUNTY AU Drawer NO,••
Deduction approved in the amount of: • 22'
20 20 20 20 Card NO. .... .5.J/6Q
1 �_
Signature of County Auditor County Date(month,day,year) -
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 I contract buyer of the aforementioned property on date application is filed.
Sig tote(owners full name)/ , -- Date(month,day,year) •
-
Fy�sident address of applicant(number street,city,5 and ZIP code)
/66yR F ?on s •
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.