HomeMy WebLinkAboutHomestead_Johnson (6) ., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
,_;=rIe4 q FOR DEDUCTION FROM ASSESSED VALUATION
l_ State Form 43709(R12/6-14) g® gy
�� Prescribed by Department of Local Government Finance � g p . }H File Mark
INSTRUCTIONS: 1 AAA g-/
To be filed in person or by mail. tf�1 tt� CC Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for wpidhJthNdedi2c0c15T is sought. �"
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is Y^' County Auditor
located on or before January 5 of the immediately succeeding calendar -.r. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must fil- i. • j, gllji•uditor of the county 1
where the property is located during the twelve(12)months before Mss.' 0!An l-.r lie deduction is sought.
See reverse side for.•&Clonal instructions and qualifications. Ci 1 B 5 U'I V K
Applicant(owner or•• ic il uyer-see resit' 'ons on to -rse side)
A_ _1.7.31.. ( ws.II ALA iS—.
D's%• Key nu . I legal d saiption Reco d number Page number/
le�J � —� 3� uoe'CO/ s�ol9 ago/ 3 a®
An• sed 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,current year rr--��0 CO date of application legal or equitable owner?
ea/Or
/ /CO ❑ Yes ❑ No
If no,what is his/her exact share of interest? f 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
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
(yroin
Address of mortgagee or contract seller(num r 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)
DnPs applicant a — -'--'-"':t? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? I current year? ❑Yes ❑No
A person is not ie person's mortgage or contract indebtedness that is recorded in the county
recorder's office (/`, .county recorder's office)that is the basis for the deduction.
D 1'a ll'CI- NO `-^^^ ig— iAUDITOR .
Deduction apprc 1?Jo l
Card NO. J OJ
20 I a, I I 20 20 20 a
Signature • ,ry rtor County Date(month day,year)
■� j �� 1,39(4) � ,� JO ar9 �S
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 afo ementioned property on date application is filed.
ignalure iv /s full name) Date(month,day,year)c7 ull resident address of ap ' nt(number and street,city,state,and ZIP code)
309 ea— 1o2c rSr; t1h h/ 'ao(c)£ TA,' x/76 .
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.