HomeMy WebLinkAboutMortgage_Dodson v" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-z`t4 FOR DEDUCTION FROM ASSESSED VALUATION
fi` `€" State Form 43709(R12/6-14)
0 ;r, Prescribed by Department of Local Government Finance 1 1 it ID
INSTRUCTIONS: • 1g 11 ��1tlLJJJ ID
To be filed in person or by mail. Form filed with:
-
F i l i n g Dates: 1) Real Property:Must be completed and dated i n the calendar year f o r which the deduction i s sought.H i m Mp-_I
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property Ii. LAM Ull_j County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of unty�
where the property is located during the twelve(12)months before March 31 of each year the deduc
See reverse sid for additional instructions and qualifications. (;IRSCIN COUNTY AUDITOR
Applicant(o er o{o cont buyer-see re ' ' son rave side) •
j��is'' r/31��// Ivey number/I al description Record number Page number
l-0 1 d /F-/3- a,004. 7J7 -- a� )01 0 Page `"I 7
Assessed value 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 1,current year date of ap lication legal or equitable owner?
- 6 V O O 0 ❑ 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 he property in question:Annually Assessed
Real Property ❑ Annually Assessed
///111 Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller ' '- ,%'
' �„/ Q ///. ///,
JAddress of mortgagee or contract seller(number and street city,state,an P code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing Distdd? / / Son
other county _
in Indiana? ❑Yes El //(/D
A person is not entitled to this deduction unless the person has a balance on the person' Drawer N O,,, ,,•,..`..Y.... ounty
recorder's office(including any home equity line of credit that is recorded in the county A
COUNTY AUDITO
Deduction approved in the amount of: Card NO. /2
20 20 20 20 20 I 20 I 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 •y.i s• n m: Date(month,day,year)
/ Opp4. .
Full --:e a•- ess• ap cant(ti'rbecrand- --Lpity,state, dZ1��°e) �j
Person authorized by du executed Power of Attorney 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 510,000. .