HomeMy WebLinkAboutMortgage_Miller (8) a° STATEMENT OF MORTGAGE OR CONTRACT INDEBT ESS Coun Township Year
.2 -°\�--t.1 FOR DEDUCTION FROM ASSESSED VALUATION
, '`-.-, State Form 43709(R12/6-14) �� �I
''‘'; / Prescribed by Department of Local Government Finance
INSTRUCTIONS: MAY 1 7 2016 File Mark
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 dedu bn is sought. t
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Must be filed or postmarked with the County Auditor or County Recorder of the co KY
rfYT� County Auditor
located on or before January 5 of the immediately succeeding calendar yeaffl�eS LI'Mdr�f ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file wa r Q ,At(g gi
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for addition aa►►tI instructions and qualifications.
Applicant(owner or contra a restrictions on erne side•T i °° Key number/I I d ption Record nu per Page number
o (� qa-aS�0a-&xi "op— i6 /7(s
Assessed value of real property as of Mortgage/WI indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,cure —^ date of application legal or equitable owner?
�l lJ1 ❑ 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)
Name of mortgagee or contact seller 1�
•Address of mortgagee or contract seller(number and street,city/sstate,and ZIP code)
Name of assignee or other owner or hold ----- '--°--_______ _
Address of assignee(number and street
Does applicant own property in any I D ra we r No•• � deduction been requested If yes,state amount of deduction
for
in Indiana? ❑Yes ❑No year? ❑Yes 111 No
A person is not entitled to this ded CH t•u I r age or contract indebtedness that is recorded in the county
recorder's office(including any ho \C• •.../•• C 's office)that is the basis for the deduction. .
�J.^...
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 wnefsfu/l name) Date(month,day,year)
,t
ull resident address of ppllcant(number and street,city,state,and ZIP code)
.5 0 0 5_ ✓tit a..,:, S ¢• h¢- &/tx.. el r Zn . Y 7G y
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I 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 S10,000.