HomeMy WebLinkAboutMortgage_Stevens (2) ^•n,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEENE= CO �;� Township Year
• FOR DEDUCTION FROM ASSESSED VALUATION C
State Form 43709(partme 4) J�1 �
5;��� Prescribed by Department of Local Government Finance ,_ A
INSTRUCTIONS: ' NSV PUDt�lie Mark
To be filed in person or by mail. N GOU Form filed with:
Firing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the des 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. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly: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 is sought.
See reverse side for additional instructions and qualifications. .
Applicant(owner, • tract buyer-see restnctio-son reverse side)
1.41hI Da _ SI _'7 f _••n / r • i
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T- 'ng,t• 1 Key number/legal description Record number Page number
r" 2 /�j/a-O7-Z.Oz - On0. 07(o6'a_ g / 5 9/3 -7
Assessed value of real property as of I Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year I March 1,current year date of application legal or equitable owner?
• /O00 0 ❑ 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 Assessed
fV.Aeal Property ❑ Annually A 'essed
']^' Mobile Home(IC 6-1.1-7)
Name of mo gages o contact seller)
cf— (-9 21_
Address of mortgagee or con'.4 I- (number a 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? ction
other county �/
in Indiana? ❑Yes ❑No 1 _ / l
A person is not entitled to this deduction unless the person has a balance on the per -1 b U �'�M QS�F� county
recorder's office(including any home equity line of credit that is recorded in the cow ///�11
• - COUNTYAUI h—quri
Deduction approved in the amount of: / 1
20 20 _ 20 20
I
Signature of County Auditor County Date(month,day,year)
I 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/contract buyer of the aforementioned property on date application is filed.
Signature(owners full game) ± Date(month,day,year)
�-
Full resident address of applicant(number and stree,and ZI e)
poi CL E • Vkscun is ecss\-• • r; ncit-ant-, -nu 47 `70
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$10,000. .