HomeMy WebLinkAboutMortgage_Lassiter f`}`r FOR DEDUCTION FROM ASSESSED VALU CATION INDEBTEDNESS "1' Township Year
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.` '2:' State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: '� Z016 File Mark
To be filed in person or by mail. �U N Form filed with:
Filing Dates 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought ,r
Must be filed or postmarked with the County Au etor or County Recorder of the,.. n f: ;;l-property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. I., :/x11'• ❑ County Recorder
2) M o b i l e/M a n u f a c t u r e d Homes not assessed as Real P r o p e r t y:M u s t fi l e w i t h : ..�41 • . .. .'i. -ot.:.my
where the properly is located during the twelve(12)months before Ma r�(BS9 • •-- , -deduction is sought
See reverse(�side�for radditional innstrucurcctti000nnnssa_and qualifications.
District Key numbr!legal desrnptam Record number Page number
oc 24 .-, -ol,- goo a) /. 4'3'S' 0;2 7 aoii 9074.3 Assessed value of real prope as of Mortgage!Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment dam,current year assessment date,current year date of application legal or equitable owner?
0 Yes 0 No
If no,what is his l her exact share of interest? If owned with someone other than cpnuve,indicate with whom
If name on record is different than that of applicant,indicate below ' 11Iss��thee property in question:Annually Assessed
lX?eal Property ❑ Annually Assessed
/ Mobile Home(IC 6-1.1-7)
Name of mortgagee /ymtra
/
Address of mortgagee or contract seer(number and L city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage -- - - _ - _ -
Address of assignee(number and street,city,state,and ZIP code) e N O..a t /...
Drawer r J/.//.
Does applicant own property in any If yes,what county? What Taxing District? Has this d 9:at-is
`
other
n IInndiannaa?ry ❑Yes ❑No currrennt ye Card NO, `Ta`- 3
A person is not entitled to this deduction unless the person has balance on the person's mortgaf "'.. .•••••••...tatty
reorders office(mcuding any home equity line of credit that is recorded in the county recorder's
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 tiled.
Signature(ovmer's full name) /1 n - _. Date(month,day,year)
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/ l P I . 4 A 22 Q'OCw JtA9A .
Full resident address of appfaant(number and street dTy,state,and ZIP code) ��
.� 8 F i a kp 7�WO-- - fQ uutAbe. P�I,un 9n,
Person authorized by duly executed Power of Attorney or by IC 8-1.1-12-0.7 1 Date(month,day,}war)
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.