HomeMy WebLinkAboutMortgage_Dunn ,per STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
E'7:,::::1_1( FOR DEDUCTION FROM ASSESSED VALUATION
State Fonn 43709(R13110-15)
F � Prescribed by Department of Local Government Finance
INSTRUCTIONS: • File Mark
To be Ned in person or by mail. .ni filed with:
Filing Dates 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is so ;
g
Must be filed or postmarked with the County Auditor or County Recorder of the county where s I rN•unty Auditor .
located on or before January 5 of the immediately succeeding calendar year. il County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property: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 deductiosoflAt 2018
See reverse side for additional instructions and qualifications. r ""11
Apph t(4owner or conq rest rse side)
Jc\nrn cv0 uo. Win • et — ns•f
Twang Key numberl legal GIBSON pl morn
MO kti "It/. 26- 11-1 - —20D-0 DO . c3D -029-- 26 I •
Assessed value of real property as Mortgage 1 Contract irSebtedness unpaid as of Mortgage/Contract indebtedness npaid as of Is the applicant the sole
assessment data,current year assessment date,current year date�� legal or equitable owner?
(7rl}— • ❑ Yes ❑ No
If no,what is his 1 her exact share of interest? If owned with other cpu.ee,indicate with whom
If name on record is different than that of applicant.State below. in question Annually Assessed
I�'Real Property ❑ Annually Assessed
• T Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 01d ( ,r _ _
Address of mortgagee or contract seller(number and street city,stare,and ZIP code) ., J o f)/J /A• `)4 N AI
Name of assignee or other owner or holder of mortgage ��,l t •r r_,;f A.�rA N id
Address of assignee(number and sheet dry,state,and ZIP code) // 4 1 f 31/� /)' 31 4t. g 3
Does applicant own property in any If yes,what county? What Taxing District'? O Lb /t/ 4--r!a ,J e-/ if r'J k-- n
other county
in Indiana? ❑Yes ❑No , ,
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County - Date(month,day,year)
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 Red.
X res re furl name) Date(month,day,year)
resident address of appbrant(number and sheet dty,state,and ZIP code)
)C SS Se 5 o44 -Perry-Qom) /_,'t Priw✓c 4 ip r . L,l or i 0
Person authorized by duty executed Power of Attorney or by IC 6-1.1- 7 Date(month,day,year)
Address of authorized person (number and street city,state,and EP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.