HomeMy WebLinkAboutMortgage_Farris c°o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
.,�t? FOR DEDUCTION FROM ASSESSED VALUATION
�;�i�' State Form 43709(R12/614) �1-�t I
\ / Prescribed by Department of Local Government Finance g6p�i 1YryI -
INSTRUCTIONS: ��YIIJJ
To be tiled in person or by mail. F rm filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. FEB 2-5 6
Must be filed or postmarked with the CountyAuditor or County Recorder of the county where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. • • Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the , rI ' imrGC_
where the property is located during the twelve(12)months before March 31 of each year the dedit, ^0
See reverse side for additional instructions and qua lifications. L'I�°' •1UNTYAUDITOR
Apply
Key number/leg74es ription Record number Page numb
X6 -- /, -o 7 — 1103 -D00. 7 ) 0 -0 i' 8 . / lo 5-8
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contras indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March 1,current year date of application legal or equitable owner?
Sl, (7QD ❑ 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 Properly ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(num and street,city,state,and ZIP code) S-
i— -
1 Name of assignee or other owner or holder of mortgage ��S
r PRP C _
Address of of ass (number and street,aJtl:state,and ZIP code) /8E j- �'
Does applicant own property in any what county? What Taxing District? Has tI- lJ
other county on pn /
in Indiana? ❑Yes ❑No curre /15�� ...a-8(3
A person is not entitled to this deduction unless the person has a balance on the person's mortgage c, - my
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that la..
I 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/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.
` Signature(ownn9 p,//naam�e) n Date(month,day,year)
7� vi�-�C L.94,1ritG ctl '
ull resident address of applicant(number and street city,state,and ZIP code)
704 S, PRINK: r1R) n1C(tO$5_i-LJ 47 (07o
Person authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 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.