HomeMy WebLinkAboutMortgage_Tison —,,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
-e__ 5 FOR DEDUCTION FROM ASSESSED VALUATION ��
j State Form 43709(R72/614)
°; --e Prescribed by Department of Local Government Finance
INSTRUCTIONS: I it:'Mar•)I ft
To be filed in person or by mail. "7"..Rrie'
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is DEC t}� t;r!tY Audi`Of
located on or before January 5 of the immediately succeeding calendar year. `� ty 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 deduction is sou _
See reverse side for additional instructions and qualifications.
1 GIB�o
Applicant(o ner or contract buye -see restrictions on reverse side) �NIY AUDITOR
Taxing Di tric Key number/legal description Recordpumber Page number
I , • " 81m y
-h7-0 / - L103 .000. 76 -oot"
1 (0 '11
Assessed lof real• as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,anent year March 1,current year date of application legal or equitable owner?
Q 0 Q D ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone otherman spouse,indicate with whom
1 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 /✓l/
Address of mortgagee or contract seller(number and street,city ate,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Pr .5-E -'-_3 - /J- te.-3_5, 4 c-
Does applicant own pr °�.1 What Taxing District? Has this _ —1•"-
other county on p
in Indiana? ❑Y ��/1�p curt
recorder's person is not entil TYv !.Q /�„-c „r ' unty re n 'unfy
A person's once entil ` 'lam//7 >unty recr
f /1, /)�,/a Q ,UDITOR
Deduction approved �'l•��� "� iC/�-�'�� 7 1 S0V\--
.. — 2 v,
20 t • 1 _
rte ��e \ \v`-3 c�UX
Signature of CountP OC l O ( County 0 1 I We certify uneer uum motion is to J 0 , C QM �� and
owner/contract buyer of the aforementionea prupo.., _.. s filed.
Signatu w 11 na c —� - I 1
1F•II s taadWdrr of applicant(number and street,city,state.and IP code) I \W
\
\I (9qn Li ,uo�2�4c s-� nwbvs \
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7
I
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.