HomeMy WebLinkAboutMortgage_Stallings Jr ;In. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township I Year
<-.2,„ FOR DEDUCTION FROM ASSESSED VALUATION F IL E T)
f State Form 43709(R12/6-14)
C-5, 2 Prescribed by Department of Local Government Finance .
INSTRUCTIONS: AN at I
To be filed in person or by mail. r o' .': r',h: ,
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 property is . Mt Coo. A .'tor
located on or before January 5 of the immediately succeeding calendar year. ,' ' V'7771; ty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of talasoN CO N a A • -
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse s' a for additional instructions and qualifications.
Applicant(o Of
)\fid buyer-see res}irtion n erse -07.1
Taxing Dis Key number I legal description Recur n mber Page nu tier
6 -II -ot - goo -Cn1. oa1- oaf b
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,anent year March 1,current vnn date of application legal or equitable owner?
f r5_r7-) ❑ Yes 0 N
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 Ascecsed
❑ Real Property ❑ Annually Acspcsed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
1
Address of assignee(number and sfreer —'
Does applicant own property in any If I ' Q deduction been requested If yes,state amount of deduction
other county f 1 ,1 rty for
in Indiana? ❑Yes ❑No t (. Y•\••• ear? ❑Yes ❑No
I-:1\\'Cl-
A person is not entitled to this deduc. (� 7e or contract indebtedness that is recorded in the county
recorder's office(including any home \ O office)that is the basis for the deduction.
Card NO. . .
............ .
Deduction approved in the amount of:
20 20 _ I __ I 20 20 20
I
Signature of County Auditor County Date(month,day,year)
II 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
own r I contract buyer of the aforementioned property on date application is filed.
Sigr ure wners`/ull name) Date month,da ear)I
rig((e A -n.
Date f—ib
Ft] l l eo a `^`of applicant l (n; d beet,city,s te,and ZIP code)(' ^C,er 11
Person authorized by duly executedr of 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.