HomeMy WebLinkAboutMortgage_Miskell (4) a...nc STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I J� ty Township Year
�_ FOR DEDUCTION FROM ASSESSED VALUATION 1�
State Form 43709(R12/6-14) - pN E
��`' Prescribed by Department of Local Government Finance
INSTRUCTIONS: JUN 1 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 deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the coup Q ere th,.roc:.o County Auditor
located on or before January 5 of the immediately succeeding calendar year. g • 7jrl11jj;
2) Mobile/Manufactured Homes not assessed as Real Property Must file with@18SQplO w , p�ypg�[� ❑ County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction Ys`�bLgAP
See reverse side for additional instructions and qualifications.
Applicant(owner or tbuyer- stncdons on ve side) �/ /
4 CO 'hand . M/..5. �
T-II/•ist ct / Ke umber/legal description Reco number ' Page number
1 11 • a (o-//—/5-/Qt -Cbf4 (LS0 -Od7 O/(0 ' (�y�/`4'
Assessed value of real;rope as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March e y r date of application legal or equitable owner?
1
� OOD ❑ Yes El No
If no,what is his/her exact share of interest? i 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 contract seller f TF:elk
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
-
Address of assignee(num)n---'-
Does applicant own prop `/7^/ ({n� Has this deduction been requested If yes,state amount of deduction
other county (/ ,�/`�`• on property for
in Indiana? ❑Yes t ••• current year? ❑Yes ❑No
D17VA'Cl" 1
A person is not entitled. :on's mortgage or contract indebtedness that is recorded in the county
recorder's office(includi. D•• ..• • y recorder's office)that is the basis for the deduction.
Card N0• AUDITOR .
Deduction approved in the:
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.
irate ( wri name ^ Date(month,day,year)„iv
ull resident address of applicant(number and street,city,,yate,and ZIP code)
Aqis S. 3dS W. 9'lit Ar_c-ChcIA .._sKI g4',v19
Person authorized by duly 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$10,000.