HomeMy WebLinkAboutMortgage_Shuttle (2) ,n4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coon Township Year
.-ss` :? FOR DEDUCTION FROM ASSESSED VALUATION
' : „ State Form 43709(R12/6-14) f
\� t Prescribed by Department of Local Government Finance =� �.
Fi'e , .- a
INSTRUCTIONS: _
To be filed in person or by mail. OCT Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. r /�'C
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is `Cblrnty Auditor
located on or before January 5 of the immediately succeeding calendar year. Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor GMet,q •where the property is located during the twelve(12)months before March 31 of each year the deductiorYls S16r(q
See reverse side for additional instruction and qualifications. LINT I
Y AUDITOR
Apace. er or cmyaU buyer-see re Ins on e side)
T- r Fct �/(/yC-J, Key number l legal desui n Record nurybar Pa e4ber
value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sol
March 1,current year March 1,current year date of application legal or equitable owner?
8.�ref / ❑ Yes ❑ No
If no,what k his/her exact share of interest? If owned with someone o er 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
Home Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller Q /3 Addre ss of mortgagee or contract seller(number and screOCIO/rgatt
,state,and ZIP code) /
Name of assignee or of.
f < c1c\ 1S /Address of assignee(nu f ,
Does applicant own ro; (i Has this deduction been re•uested If es,state amoyatyf deduction
other�unry p ��a,�S on property for y 7. 9t
in Indiana? ❑Yes (�( 1 current year? ❑Yes ❑No /. /�
A person is not entitlet ���� 1 , son's mortgage or contract indebtedness that is recorded in the county
recorder's office(inclu r fp" .�1-l( 1ty recorder's office)that is the basis for the deduction.
...\—{acearfl. \ \an )ITOR .
Deduction approved in ti I N
20 C C A j . Li-C i 20 20 20
Signature of County Aud ,923D.a lJ J / ( inty Date(month,day,year)
I I We certify under ) L/12 i 0 0 m is true and correct and that the applicant is a resident of Indiana and
Ammer I contract Ix l
Ammer
(owner's full n Date(month,day,year)
* `I_ --IAA 13 J t,k-(N J
resident address of ap licant(number and street,city,state,and ZIP code)
X ' 1 N , )JD° y,S `Pc-tt • zrl COui tLA
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. ..