HomeMy WebLinkAboutMortgage_Hadley (2) .n•. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
f' . FOR DEDUCTION FROM ASSESSED VALUATION Coun wnship Year
n.i
•a,-f t" State Form 43709(R12/6-14) •
6 ?r" Prescribed by Department of Local Government Finance
INSTRUCTIONS: APR 2 1 2016File Mark
To be filed in person or by mall. 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 tfyLl proper f c.qy ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Coung((),ggim pf,eigiS Titj AUL,I
where the property is located during the twelve(12)months before March 31 of each ye uc on is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contracctQb}Jar-see resbi ' son reverse s
,//fl it- • lC/ ar i • , • %, Al •. /ice.
Taxin istriG Key number/legal description 411 Record number Page number
f a4,-cc?-v`"7- 0(3 eon y-oil c7on 9 L10_541
Assessed vale of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March wrrent year date of application legal or equitable owner?
. 74Q 666 0 Yes 0 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 contact seller d 4... 8 0
r
Address of mortgagee or contract seller and street,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) -4-O p pj
Does applicant own property in any If yes,what county? What Taxing District? Has d a0r ft`l-,l() �s c.
other county on prc V.
in Indiana? ❑Yes ❑No tuner
A person is not entitled to this deduction unless the person has a balance on the person's mon is Ll U b b C�
recorder's office(including any home equity line of credit that is recorded in the county recorde i
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 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(owner's full name) Date(month,day,year)
y C•[AiXI J- 6,i/, _ .
Full resident address of applicant(num• nd street,city;state,and ZIP code)
>.gW/ E. SE 66. - . , , Ztl ii761/0
Person authorized by duly executed Power: Attomey 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$10,000.