HomeMy WebLinkAboutMortgage_Mullen Ro Count Township Year
ct : FOR DEDUCTION FROM ASSESSED VALUATION
d!X STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'• Stare Form 43709(R12/6-14)
k- > Prescribed by Department of Local Government Finance - a 'Illn■
INSTRUCTIONS:
Fitz .
To be filed 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 is sought. G.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properttAN 2 • tpounty Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) •bile/Manufactured Homes not assessed as Real Property:Must tile with the County Auditor of the cou ty
w ere the property is located during the twelve(12)months before March 31 of each year the deduction is 1 1 pht.• �/
•See reverse sid- or additional instructions ands alificationsl
Applicant egrcont ee restri dot rev: //
• • • ,t
Key um•-r/legal descripti Record number Page number
ti- i.
�-' / 3-4 r -4Q . . - lJd 6 e0/,/- . _ D
value of real property: • 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 appli off�'' //� legal or equitable owner?
/ /x dUU ❑ 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 Q� �
•
Address of mortgagee or contact seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage //� ��(y/, ,-,/�f 9 �/n//��j
Address of assignee(number and street,city,state,and ZIP code) f /I C g�(/1 / c A'
Does applicant own property in any ' If yes,what county? what Taxing District? Ha this deduction been requested If yes,sate amount of deduction�'
other county on property for
in Indiana? ❑Yes ❑No current year? ❑Yes ❑No
A person is n - `---`glance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's of M I ' orded in the county recorder's office)that is the basis for the deduction.
/ I , /K•N/ /W_•,'••+ COUNTY AUDITOR
Deduction ap n
deesitttikaa 20_ r 20 20 20 20
Signature of /. 55 County Date(month,day,year)
I I We o Dregoing information is true and correct and that the applicant is a resident of Indiana and
owner/__......—uuyer at me aforementioned property on date application is filed.
1 Si rlelure So rter's f nameL m Date(month,day,year)
I4U JN)
Full resident address applicant( mberand street,city,state,and ZIP code)
114 I q 2 3 Oakland CA-1/44 , nl Lt rk,Lon
Person authorized by duly executed Power of Attomey 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 tine not to exceed 510,000.