HomeMy WebLinkAboutMortgage_Rich (2) e' R.w STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14)
Prescribed by Department of Local Government Finance F tiii.. E it,
INSTRUCTIONS:
File Mark
To be filed in person or by mail. JAN F:lin-(r vith:
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 ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year •f Ij_•_' unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the courF.YYdM
where the property is located during the twelve(12)months before March 31 of each year the deduc$IBBflptiCO • 1 • • •
See reverse side for additional instructions and qu ations.
Ap.scant(o er or load er-see .Mc6 s re rse si
)
ink
T. n• • dc Key ber egal description
Re...,numb eV Page e
`��wi,_ dr a ,— a — / o' / W M-OM / /- 6'0,77 e l/(a
Assessed va e of real as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract i ebtedness unpaid as of Is the applicant the sole
March 1,anent y March 1,current year date of a/pplirya}io 1 legal or equitable owner?
u x Ai legal
❑ 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 t e property in question:Annually Assessed
Real Property ❑ Annually Assessed
9 /
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller e• 0
Address of mortgagee or contract se le ber and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
1 Address of assignee(number and street,city,state,and ZIP code) a jO
IDoes applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in�idiana? Ill Yes ❑No current year? ❑Yes ❑No
A 1 3 balance on the person's mortgage or contract indebtedness that is recorded in the county
ref arecorded in the county recorder's office)that is the basis for the deduction.
/Cfr) M1/1,/)11r , COUNTY AUDITOR
n m I/ I- ncrr 20 20 20 20
S I/D /// �l-I 1 County Date(month,day,year)
C0 1 �aJ 5 I foregoing information is true and correct and that the applicant is a resident of Indiana and
�,� (/ ate application is filed.
i. (J t 1 �Q. Ld ' 1 Date(month,day,year)
I i-(2 e ii9 c73-o IP code) '
I 2-0.7 Date(month,day.year)
00 I Le — 13 I cue,
•
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.