HomeMy WebLinkAboutMortgage_Sherman (2) •an4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Township Year
:-)�>�' £ FOR DEDUCTION FROM ASSESSED VALUATION ��
I` State Form 43709(R72/614) . 1
c* `„9 Prescribed by Department of Local Government Finance i� in,'
INSTRUCTIONS:
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. ii 1 5 211b
Must be filed or postmarked with the County Auditor or County Recorder of the county where the p I County Auditor
located on or before January 5 of the immediately succeeding calendar year. • . my Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Aud for of th: ..unty i .E/
where the property is located during the twelve(12)months before March 31 of each year the deducti•a.,s• rl"ice►^
See reverse side for additional instructions and qualifications. CIRSON COUNTY AUDITOR
AppG nt((miner or contract buyer- e restrictions on reverse side))
T i D�/'l Key number egal�ption/ Record number Page number
laril4'� a61,1-13 _3o0 -et/. y )_ 6 - ooi 7 a�or , isa3
Assessed value of real 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,current year date of application or equitable owner?
j34000 ❑ 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 the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller — —
Address of mortgagee or contract seller(number and street cityt,dty,state,
Name of assignee or other owner or holder of mortgage Drawer NO, o-0J�o
Address of assignee(number and street,city,state,and ZIP code)
Card NO. ... t5-023....Does applicant own property in any If yes,what county? What Taxing District? Has this c n
other county on proper
in Indiana? ❑Yes ❑No current yr
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness war is rew,up,......._ _.runty
recorder's office(including any home equity line 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 I 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 I contract buyer of the aforementioned property on date application is filed.
Si nature(owners hull naq��) Date(month,day,year)
fill a .d 11.Ebi �/L
Fu sident ad ess of applicant(number and street,city,state,and ZIP code)
1 Li? r5 1(00 W Trinctthh I N 1-111g10
_\ Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
O)�Address of authorized person (number and street,city,state,and ZIP code)
TTT The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.