HomeMy WebLinkAboutMortgage_Brown (6) "�`e STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
e._ FOR DEDUCTION FROM ASSESSED VALUATION
j State Prescribed 43709 Department\,e Prescribed by Department of Local Government Finance
ILF
INSTRUCTIONS: 110 ark
.
To be filed in person or by mail. II n Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought
2 2 201
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. e �)' �i County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor. r;•. ... t•, -4(
where the property is located during the twelve(12)months before March 31 of each year tnissbegce its p.,' AUDITOR
See reverse side for additional instructions and qualifications. ; ./'y►J\/
Appli t'((o�.w,(nneer`�o'rr contract buyer-see re lions nreverse side) /�;" --
T nilstrict Key number/legal des iption Record number Page number
A 3
- /8- 36 - a0 - oo/. 97 2 o i y Ito 07,3 y
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
1 '7q 000 El 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:
Q/ cti /ut-/�,/ ^'"•e«?csed_
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Name of mortgagee or contract seller E T F 6 4 /// eiy y / d` 1r1,-21,—, —
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) /l-�(/� r
Name of assignee or other owner or holder of mortgage 4./ 7 —
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Address of assignee(number and street city,state,and ZIP code)
—� - A , ,_t- c ?-- . /
Does applicant own property in any If yes,what cou 1. What Taxing District? P. d-'/G 0 d 0 S t7 R 3 7
other county o
in Indiana? ❑yes ❑No c
A person is not entitled to this deduction unless the person has a balance on the person's rnty
recorder's office(including any home equity line of credit that is recorded in the county rec G°i.pF, 3 U/IL•.rt / !wt,C_r . 72-de_ n-J
COUNTY AUDITOF e),L h` UQ7rm.
Deduction approved in the amount of:
20 20 1 20 20 _
/ —da - 0,--0/C.Signature of County Auditor County
I/We certify under the penalty of perjury that the above and foregoing information is' and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name)
Ful{.f ident address of applicant( ber and street,city, fe,and ZIP ecpd )
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Person authorized by duly executed Power of Attorney or by IC 61.1-12-0.7
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 One not to exceed 510,000. ir ir