HomeMy WebLinkAboutMortgage_Jones (5) an STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Forth 43709(R12/6-14) -
„„ Prescribed by Department of Local Government Finance �/
INSTRUCTIONS: File Mark'
To be filed in person or by mail JUN :. . 5! .. :
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 county where the properly is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. , -V1041.1,�! ty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of ttis
co
where the property is located during the twelve(12)months before March 31 of each year the deduction isso•• I. �-' • i • -
See reverse side for additional instructions and qualifications.
Applicant(owne or contract buyer-see�esurctions on revetse side)
1AM 4 ryJ1C� 7LTL.�11
'lazing District i ) Key number/legal description Record u ber Page number
1c1J A_r : r-it-, a.b-1a-ba- at) t - 001 .155 -Date P” e2 •R y9
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year Mardi 1,Current year date of application legal or equitable owner?
1 (5 n [ 'es ❑ No
If no,what is his/her exact share of interest? J If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate beirew - I Is the property in question:Annually Assessed
t> MLA E . rye[_ , 1 Lai Property ❑ Annually Assessed
(J,��/1 /)� Mobile Home(IC 6-1.1-7)
Na e f mortgagee or contract sell..` Drawer NO.... ca.
Address of mortgagee or contract seller(number and stn
. Card NO 1
Name of assignee or other owner or holder of mortgage Y Ch 'a Is O -k4, Q c (3,C.
Address of assignee(number and street,city,state,and ZIP code) YJ
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county , property for
in Indiana? Yes III No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity fine of credit that is recorded in the county recorder's office)that is the basis for the deduction.
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 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 I contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day,year)
�7 of �. S�ua dZIP �.
0 resident address of applicant(number and street,city, ��,and ZIP code
903 E . V.V.At r .ck . tr.rx--br. .T 4-1 671 0
erson 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 510,000.