HomeMy WebLinkAboutMortgage_B & M Automotive Llc q STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township 1 Year
�e_ ) FOR DEDUCTION FROM ASSESSED VALUATION �{I ��{{--��
. -� State Form 43709(R12/6-14) �p�-1 R I E p H
+�,_� / Prescribed by Department of Local Government Finance 4 ` I I)
INSTRUCTIONS: .1 File Mark
To be filed in person or by mail. FEB 8 018"filed with:
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 -II aunty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of th- L .%^I1/1'r
where the property is located during the twelve(12)months before March 31 of each year the cfspistioyi NTY AU• • "
See reverse side for additional instructions and qualifications.
Appli 1t(owner or contract buyer-see restrictions on reverse side)
IOTaxing w L strict Key number/legal description Record number Page number
0a)1 a4, - v-t-IS- 30Y " O OD. 4y0 - 007 J-OI (o y `f1
Assessed value of real pmpe 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?
SS 000 ❑ 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 ortractor seller
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage ``�
Address of assignee(num •and street,city,sate-and ZIP code) (3 d to tn,0 VINO \•\ e L— •
.2eu- -it-d 1, 5 Per/ 4 Pr i3-'-L / O }o a. P s, G
'Does applicant own property in an If yes,what county? What Taxing District? Has this d Lt other county on propert a � tV1 CD R
in Indiana? ❑Yes 0 N current yet At 000
A person is not entitled to this deduction unless the person has a balance on the person's mortgag. L j(p
recorder's office(including any home equity line of credit that is recorded in the county recorder's o �_ y' _--._...
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 1 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I I We ce.ify 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/ an t b -r of the aforementioned property on date application is filed.
Signatur •w s sf f I e) Date(month,day,year)
X d4
S. allit.
Full -sident ad i of applicant(num" and street, state,and ZIP code)
F/3/ S�/ 4 J s 7 ca L-A4(z /:a�yz(�
rson authorized by duly executed Power of Attorney or by IC 6- 1-1 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.