HomeMy WebLinkAboutMortgage_Miller (3) / 44\ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
t ' FOR DEDUCTION FROM ASSESSED VALUATION FILED
State Fortn 43709(R72/614). . Prescribed by Department of Local Government Finance
INSTRUCTIONS: File
ggM,,ark
To be filed in person or by mail. FEB 'Tornhh:
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. I r__! -ecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the count •IT111i
where the property is located during the twelve(12)months before March 31 of each year the deductialB&OthtCO'i 1 • AUDITOR
See reverse sit rr additional instructions and qu lifications.
Applicant(ow- o f. tract buyer-see restrictions re rse sr )
Taxing[eeMd /�ey r/legal des ' ion Record number Page number
-riG-0- *G .or/_ 003 do/3- 07a/ 9
value of real property as of 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 appl/ira/y'�, legal or equitable owner?
! ✓/ ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than 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 Z n lji /a�
Address of mortgagee or contract seller(nunum(beerrJannd\stt/reeeet street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage /`
Address of assignee(number and street.city,state,and ZIP code) (/ ,/ „� /�//6
Does applicant own property in any If yes,what county? What Taxing District? Has thi dHluction been requested If yes,state amount of deduction
other county on property for
in Indiana? yes No current year? ❑
ID Yes ❑No
A person is not entitled to this deduction unless the person has a ba lance 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 .
Dedur ^^
. Drawer NO �n )(5 _ 20 20 20 20
•
Signs �O 'n County Date(month,day.year)
Card NO. 4 x--11
I/ and foregoing information is true and correct and that the applicant is a resident of Indiana and
n date application is filed.
Signaturen(ownefs full name Date(month,day,year)
X -11n4°IJ71A/4 -
WII esident address (applicant number and street,city,state,and ZIP code)
l .�3gg J applicant
f 77 7,/ //C/'/7AA/0
Person authorized b my ted Power of Attorney or by IC 61.1-12-0'y Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.