HomeMy WebLinkAboutMortgage_Chandler (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Satin Township Year
\�.:,,:_ FOR DEDUCTION FROM ASSESSED VALUATION
I'." "F i` State Form 43709(R12/6-14) -•\ Prescribed by Department of Local Government Finance ii a.
t ) Y
INSTRUCTIONS: I i t�r. Mark
To be tiled in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction r h(, nt
Must be filed or postmarked with the County Auditor or County Recorder of the county wherblthA pdcpt ib 'r5 ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Aud• of the fun I,
where the property is located during the twelve(12)months before March 31 of each year th• i,
S 7y '_ -;: )4 ht.
See reverse side for additional instructions and qualifications. CISSON COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on(ever side)
Tarir7g�isin Key number/legal description Record number Page number
hc,� 02 (o - l R - o7 -tiol - voa . 3 3_ 0 � 8 poi. YioY
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 1,Current year date of application legal or equitable owner?
S 8, S5D0 ❑ 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
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
- F TFcu .
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage --— - - --- -- .
Address of assignee(nmpyer a city,state,syQr e) • �/
Ls/Q`/au✓- ntr e a Drawer NO ���IIVJJ
Does applicant own property in any If yes,what county? What Taxing District? Auction
in d a? Card NO.
o l eriaa coun ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the persc he county
recorder's office(including any home equity line of credit that is recorded in the county
COUNTY AUDITOR .
Deduction approved in the amount of.
20 20 20 20 20 20 20
Signs ure of County Audijor / -}�Jyy�—fit County Date(month,day,year)
I�certi�a penalty of perjury that 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.
ks_Signat wne/s lu�lpl ame) Date(month,day,year)
yn(i !Ilp m r ),vid e�
Full resident add( f appicant(number and reef,city,state,and ZIP code)
Ii9 5 �Icast-n -pP(�,1 �sl�ru `�„, 'P7(9 70
Person authorized by duly executed Power o 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.