HomeMy WebLinkAboutMortgage_McCoy (3) .47r, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
\....4 %r FOR DEDUCTION FROM ASSESSED VALUATION FILED
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'A State Form 43709(R1216-14)
try.) Prescribed by Department of Local Government Finance
INSTRUCTIONS: File lAark
To be filed in person or by mail. MAY 2 = j
orm 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 the prop-e is, , �n • my Auditor
located on or before January 5 of the immediately succeeding calendar year. Ii • �/'f►I � COItnly Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CountyAuddor oft+W• s �lTY AUDITOR
where the property is located during the twelve(12)months before March 31 of each year the f. -••• t.
See reverse side for additional instructions and qualifications.
Appli (owner or contract buyer-see restrictions on reverse side)
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Taxin • MotKey number/legal descript' Record number Page number
0210 - /a - oe - yoX - oo • IG3 - o2R aol0 29$ 7
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
Mardi 1,anent year March 1,current year date of application legal or equitable owner?
16 po0 ❑ 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 Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
T.
Name of mortgagee or contact seller _ - _ _
—1
Address of mortgagee or contract seller(number and sheet,city,state,and ZIP code) •
Drawer /
Name of assignee or other owner or holder of mortgage
15, l\r�........,,,(.
Address of assignee(number and street,city,state,and ZIP code) Card NO 99'
.
7i-a ✓1 4 -
Does applicant own property in any If yes,what county? What Taxing District? Has this c
other county on proper
in Indiana? ❑Yes ❑No current y _
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract u,,..,.,..
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 aeouu,,,,...
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.
Signal re(owner's full name) Date(month,day,year)
-
Full resident address of applicant(n .ber and street,city,state,and ZIP code) .
570157 I.K/, Ilcw y- /c pr - 1 f tAl`c t.rd ZN 41 7678
erson auorized by duty executed Power of AY.omey or by IC 6-1.1- 2-0.7 Date(month,day,year)
dress 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.