HomeMy WebLinkAboutMortgage_Scott Jr c STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
4t
" ki., FOR DEDUCTION FROM ASSESSED VALUATION
`' 1: Stare Form 43709(R12/6-14)
Prescribed by Department of Local Government Finance as J E it JJ
File Mark
INSTRUCTIONS: APR 15 201;Fonnfledwith:
To be filed in n person or by mail.
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 prr..erty is • •unty Auditor
located on or before January 5 of the immediately succeeding calendar year. 1,f , -41,1f"r ❑'County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County/Sudi(.. - ✓•
where the property is located during the twelve(12)months before March 31 of each year ffhh'd 43 7 •o l' -�1!hY A ! e' .
See reverse side for additional instructions and qualifications.
Appli (owner or contract buyer-¢gee restrictions
Record number Page number
41.,C0'n4-' Ato- oY - A5-Soo - 000. 57 7 - o?.o 7-ol3 (of 90
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 3 5f 001 ❑ 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 properly in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
/J �� y// Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller n� _ Cif v+"•'v
Address of mortgagee or contract seller(number street, f/Vh code)
( city;state,and ZIP code
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
et S ) 5w as / / a, . Y38f1- L
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes Ill No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recordrr°office)that is the basis for the deduction.
-
COUNTY AUDITOR .
Deduction approved in the amount of: _
Dt"a))er t\r0.. l
20 20 20 20 /'�
Signature of County Auditor County / Card f�j0. •-! —
I/We certify under the penalty of perjury that the above and foregoing information is true ana cv,,.,_. '' and
owner/contract buyer of the aforementioned property on date application is filed.
Signature woe u �not/r�r(�`/�','°�,'y''�'j Date(month,day,'}ea,,.
•
` /Full sident a of applicant(nu rend street,city,st e,and ZIP code)
/X at F2 4- (3i'esI Dr. Myloka .. 13/ µ73G6.
Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-67 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.