HomeMy WebLinkAboutMortgage_McIntyre (5) `_ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE Year
C ; ount pwnshiP
:.7 t FOR DEDUCTION FROM ASSESSED VALUATION
"' "�` State Form 43709(R1216-14) 7
.. ,, / Prescribed by Department of Local Government Finance A PR Q
2 2016 File Mark
INSTRUCTIONS:
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deductio
Must be filed or postmarked with the County Auditor or County Recorder of the U County Auditor
located on or before January 5 of the immediately succeeding calendar year. CO NTY AUDITOR County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought. ---
See reverse side for additional instructions and qualifications.
Applica t(owner or contract buyer�seee restrictions oonnreve side)
/g District Key number/legal descried() Record number Page number
�2vwc�dv✓ , (n .. / a_07 - ao3 - o03, (av0 - 0 >- 8 1.013 5(08
Assessed value of real pivyerty as of Mortgage I 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 ap ficati n legal or equitable owner?
• g) DO a ❑ 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)
4,6606,Name of mortgage r mnYact seller \-1 _ A
Address of mortgagee or contract seller(number and street,city,state,state,and ZIP code)
Si -
Name of assignee or other owner or holder of mortgage S C skC (N\CT��y rE
�ro.� (�Cr ol. I -
Addressofassignee(number and street,city,state,and ZIP code) C� -3_ 1 Ilv�v�
Does applicant own property in any If yes,what county? What Taxing District? Has N w°' l 5 o ,
other county on pro I.0- t3 Ay
in Indiana? ❑Yes ❑No curten Cs 9 1 O O C7 —
A person is not entitled to this deduction unless the person has a balance on the person's monn_ _.
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the aeouuru,,.
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/We certify under the penalty of perjury,)ttat the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/.•-... .uyer of the aforem_ needd p//pperty on/date application is filed.
Signet e(own- : n. a ���� ` 1- / Date(month,day,year)•
kFull r .'•.e t a d ess of appF t(numberand street,city, at ,and P code)
Person authorized by duly executed Power of Attorney or y 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$10,000.