HomeMy WebLinkAboutMortgage_Spalding STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�'.v County I Township I Year
,d._. . FOR DEDUCTION FROM ASSESSED VALUATION FILED
State Form 43709(R12/6-14) ED Presibed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. 2 1 2016
Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sou MQR
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. n County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor
where the property is located during the twelve(12)months before March 31 of each year ftisceftqapipary.AL DITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on verse side)
Taxing DisUict Key number/legal description Record number Page number
a� - 17-/,1 - a0/- boo. /A7 - o,ta— A00S 7979
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?
8 91 0 0 o ❑ Yes ❑ No
If no,what is his I 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)
r
Name of mortgagee or contract seller 6•
I Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage - _ __
NI Address of assignee(nurr rr and
/`""" city,state,and ZIP rode) � ~�� � Q�`�—
Does applicant own property in any If yes,what county? What Taxing District? Has thi U
other county on pro; `
in Indiana? ❑Yes ❑No current 1.. .,-- —b S
A person is not entitled to this deduction unless the person has a balance on the person's morn inty
recorder's office(including any home equity line of credit that is recorded in the county recorder 00` - q
COUNTY AUDITOR l
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.
XSi ature wner's fur f .f Date(month,day,year)
rul resi ent address oflicant(number and street,city,state,and ZIP code Y7 X 7 46
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 S10,000.