HomeMy WebLinkAboutMortgage_Carter (3) try, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
it ° FOR DEDUCTION FROM ASSESSED VALUATION
' jiG State Form 43709 y eparme14) �"'�
`O Prescribed by Department of Local Government Finance
FIL Isle
INSTRUCTIONS: File Mark
To be filed in person or by mail- (�(�7 Form tiled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for n t,T tile5ecalrbn is 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 calend. ear.
2) Mobile/Manufactured Homes not assessed as Real Property:Must I:, ;' - =-•.'' •unto(of the coun ❑ County Recorder
P 1 1 - •-':r the deduction is sought.
where the property is located during the twelve(12)months befry=.wit �r.•
See reverse for additional instructions and qualifications. N Y AUDITOR
Applicant(ov /w'�contract lbuyer-se restdcponst n revers ide�
Tarim Distri Key nu�p er I legal description Record nigher Pa9@ num er
Tailing 45 rak)-18 a4-a.o&-oc�. S 32-dab s CJtI
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 Orgill year date of application legal or equitable owner?
• 190CYO ❑ Yes ❑ No
If no,what is his/her exact share of interest? I ft 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 contact seller RS 8 C
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)(CALutcm.)-„,÷3.,
Name of assignee or other owner or holder of mortgage
C•A2�� �- LAQr2y S r)
ti-Ls 4 / What Taxing District? Has this deduction been requested If yes,state amount of deduction
on property for
. 7 current year? ❑Yes ❑No
O5-06,--3 has a balance on the person's mortgage or contract indebtedness that is recorded in the county
#10e// neC yt^Gt that is recorded in the county recorder's office)that is the basis for the deduction.
Deduction apps....-._.__
maerc46:lit COUNTY AUDITOR .
20 20 20 20 20 20 _ • 20
Signs re County Auditor I Coun Date(mont(r day,ya C
\l J C� +�\ /b—/ (J
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.
Sin veers full nan // / Date(month,day,year)
Full reset a Tess of.a,1pitoa (number and street,oty,st zand ZIP�S/Ig; �,..1444161/2) 7 r r ��-s��!
Person authorized by duly executed Power of A or by IC 6-1.1-12%![7f�— (}/Date(month,day,year)
j .
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.