HomeMy WebLinkAboutMortgage_Bennett j STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION -� IL�
State Form 43709(R12/6-14) 1 ILE t,
Litt)
1
Prescribed by Department of Local Government Finance 11 JYY���
INSTRUCTIONS: 1 File Mark
To be filed in person or by mail. MAR 1 0 201 Form 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 •`..arty is4 n ounty Auditor
located on or before January 5 of the immediately succeeding calendar year. I, iiinut ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County•+ -Fpy•( A
where the property is located during the twelve(12)months before March 31 of each year io )S .u•h.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse de)
Hrt
Taxing District Key number/legal description Record number Page nu ter
a�-d3 i! - aco ooa• /3c5 oa y aai (0 70
I Assessed 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?
3 (0o oon ❑ 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
,4,1teal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sg z r
I11 ��" 1
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) n
Name of assignee or other owner or holder of mortgage a
Address of assignee(number and street,Sy,state,and ZIP code) c'1 1 11 v--'�1 RR���f f f
Does applicant own property in any If yes,what county? What Taxing District? �z,O I ` - b rl 0 action
other county a C/-S_i _
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the perst _ > •county
recorder's office(including any home equity line of credit that is recorded in the count) d��&2 0,000.
COUNTY AUDI. ///��1 ��� .
Deduction approved in the amount of: LOPV ea �(_\
20 20 20 20 � ,
Signature of County Auditor Coun
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 wn s full na ) Date(month,day,year)
Full resident address of applicant(number and street,city,state,and ZIP code)
S aSc e r i l Ab __•
Person authorized by duty 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. -11-4 T T �� in