HomeMy WebLinkAboutMortgage_Bradshaw 4.3_...•^no STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
\\,... ....9 State Form 43709(R12/6-14)
Prescribed by Department of Local Government Finance F I I E D
INSTRUCTIONS: File Mark
To be filed in person or by mail. MAR 9 2U t•rm 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 prop-fly is aunty Auditor
located on or before January 5 of the immediately succeeding calendar year. /,r, jrlllj4 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor oft' .441
where the property is located during the twelve(12)months before March 31 of each year th - v-. 1T.Y
See reverse side for additional instructions and qualifications.
Applica wner or contract buyer-see restrictions on reverse side)
Taxyi9�O. t c Key number/legal description Record number Page number
7Av - 2- L - / X-/S - /o/- 00 d.. . FAS —od- 8 ?01 5x89
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?
60 5 op° ❑ 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 contract seller
FC LA
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) __
Name of assignee or other owner or holder of mortgage _
DI er ' .
Address of assignee(number and street,city,state,and ZIP code) a 15 l rQ••,•.
PT NLJ 18 - a - lo . 3o4c
Does applicant own property in any If yes,what county? What Taxing District? duction
other county Card. r d.l�o• ScR
in Indiana? ❑Yes ❑No - ••. •A person is not entitled to this deduction unless the person has a balance on the perso:._ '•''•• .. the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's u...,._,
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 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.
S. lure(ow /s full n e) Date(month,day,year)
F IIrreesident address of applicant(number and street,city,state,and ZIP(code) .�/ /^
X !O QM v�)/ e/v�/1-»ice l 7 h iU /�/j,L/D
Person authonz by du y 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.