HomeMy WebLinkAboutMortgage_Melchoir o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
;ab_ FOR DEDUCTION FROM ASSESSED VALUATION �
j Sate Form 43708(R12/6-14) I�L�y 11 �Ip{�-�
l Prescribed by Department of Local Government Finance tom' 5 n '`
Y Fite Plait
INSTRUCTIONS:
To be filed in person or by mail. nn filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought FEB 4 2010
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. . Dusty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of I,., ;4�ar1nfi; —
where the property is located during the twelve(12)months before March 31 of each year thG4a Fp eo•P Y AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see re rctionss n reverse side)
Taxis istrict Key number/legaKlesc.ziption Record number Page number
A aoo -o° A . 3o9- 001. 0 Zol.5- w22
ssed 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 application legal or equitable owner?
it Y8 oe o ❑ Yes ❑ No
I 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: I Is the property in question:Annually Assessed
–•CiReal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller/ T F c 7�
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) Dr"(trek NO O
Name of assignee or other owner or holder of mortgage Card 1.Q l�to. y989
Address of assgnee,(number and street,city,sate,and ZIP code) �� ` �y8;Qc_ 00 ••.•••..,,
!N-tr-dot 1aec / Ire 4
Does applicant m n property in If yes,what county? What Taxing District? Has this deduction been requested I If yes,state amou,.._
other county on property for
in Indiana? ❑Yes ill current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance 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
Deduction approved in the amount of:
20 20 20 I 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Si sat a(owne?s f II n e) Date(month,day,year)
k,' rvl —.
WI resident address of applicant(number and street,city,state,and ZIP code)
4 Z9 E fOGI.XX„7 LJM � T AT�i 1N X439
Person authorized by duly executed Power of Attorney 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 fine not to exceed 510,000.