HomeMy WebLinkAboutMortgage_Fowler tsr q STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
e - FOR DEDUCTION FROM ASSESSED VALUATION
'- - state Form 43709(R12/6-14)
----4-ii---c Prescribed by Department of Local Government Finance
INSTRUCTIONS: TT File Mark
Filing be Dates:in person Real l by ery. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the ded n s ght
Must be filed or postmarked with the County Auditor or County Recorder of the coo wh is ❑ 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 Augiiim Atilt
where the property is located during the twelve(12)months before March 31 of each year S W i ti r sought.
See reverse side for additional instructions and qualifications.
Applicant(owner contract buyer-see ti ' son revere) /] �7/�+��(
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Taxing District Key number/legal desrn °n R DITOR
number
Page number
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9
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1 ir;ejlt year date of application legal or equitable owner?
4) Uriti ❑ Yes ❑ No
If no,what is his/her exact share of in rr--
If name on record is different than that I L L� TER ^ wna%ty Assessed
lip V r��l---,(y/ wally Assessed
be Home(IC 6-1.1-7)
Name of mortgagee or contact seller
E V1 -klSUn.C. p_pag EEC f-17-i-.s
Address of mortgagee or contract set r�-� y J J /, '�]
Name of assignee or other owner or • `SID o`A`�/ `-�• DrT r/1 p_ )k)
Address of assignee(number and si $ 7b 4 6 d � /6 - / 79?
Does applicant ovm property in any mount f mount of deduction
other county
in Indiana? ❑Yes ❑No
A person is not entitled to this d. 3orded in the county
recorder's office(including any. ion.
•
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• - ; • -menl; -. . •.erty on date application is filed.
Signature owner's toll n- Date(month,day,year)
Full - rent address of applicanlde ty.-r and beet,ci st e,and ZIP code)
Pe n. thorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(main-,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 tine not to exceed 510,000.
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