HomeMy WebLinkAboutMortgage_Williamson (2) n^n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
• FOR DEDUCTION FROM ASSESSED VALUATION County t$OI Township Year
Twnship
• ,a
. t_ � State Form 43709(R12/6-14)
.\ 7 Prescribed by Department of Local Government Finance 1
File Mark
INSTRUCTIONS: SEA ,
To be Media person or by mail.
•'�'fi14�M
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 unty Recorder of the county where the property is .❑ Cou Auditor
located on or before January 5 of the immediately succee in calendar year. I. -♦
�' y 0 y n�ACrT:ii, Recorder
2) Mobile/Manufactured Homes not assessed as Real Pm erty:Must file with the County Auditor of th r,' co
where the property is located du ' the twelve(12)mont s before March 31 of each year the deduction is soug - -
See reverse side for additional instructions an q lifications. ,
Appli.=nt(•. ✓or contract buyer-seere n arse side) l
a0 QL c� Azgoa. f /!/ scot)
Taxin• %strict Ke n r/legal description Record number Page nun
rb 6 013-/G-tod- aca.d57 • 42 dais 9351
A i - value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
tr 1,current year March 1,current year date of application Q �.� legal or equitable owner?
C/19 (CD ❑ 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 a property in question:AnnuallyAssessed
Real Property ❑ Annualty Assessed
Mobile
Mobile Home(IC 6-1.1-7)
Name of mortgagee or cone'-Ilyr l /e a
Address of mortgagee or contract seller 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) 60.1 . / /� ! 2 �‘
Does applicant own property in any If yes,what county? What Taxing District? Has this dedu n been raci .ted If yyes,,sttattee amou t deduction
other county on property f // 3
in Indiana? ❑Yes ❑No current yea ❑Yes 21 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
eni wrv-nnDITOR .
Deduction approved u '\V DU Vr�kb_.S 1........ itk (�.°—YJ ec-00.
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20 k---)'l l k\C- - SC N. A 0 Cc F C,Uk 20 20 20
Signature of County A j a C t o O c - UU unty Date(month,day,year)
c
I I We certify und a4 (� — 1 7(J 1 p_tc_'� m is true and correct and that the applicant is a resident of Indiana and
owner/contract 1 J I.
e(o ow nne la s h ilt-1me)4 i& »
Date(month,day,year)
resident
address of applicant(number and street,city, ate,and ZIP code)
t■ /,330 / - If 20 E fl�fficic S/ 17639
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12- 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$10,000. -