HomeMy WebLinkAboutMortgage_Buck (3) _ 4f STATEMENT OF MORTGAGE OR CONTRACT INDEB�Q my Township Year
`.'} : FOR DEDUCTION FROM ASSESSED VALUATIO
.C..'= "t 1 State Form 43709(R12/6-14)
Si. u' Prescribed by Department of Local Government Finance
INSTRUCTIONS: JUN 2 2 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 •-ductio 's •• .
Must be filed or postmarked with the County Auditor or County Recorder of th-C•'I ■ •-in i- propertyis County Auditor
located on or before January 5 of the immediately succeeding calendar year l ����y YAUDITOR El 2) Mobile/Manufactured Homes not assessed as Real Property:Must flsZSQ6@I wm• itor of the county County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or PeP contract buyer-see
9-restrictions on reverse side) /h` I
v/) 1,/J'`/I) P4/l/.�
Ta in Istria Key number/le p n Record number Page number
�d� to -,7 - a0-1400 c OFT-6"/ cRab /4f 6,-3
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,current year date of application legal or equitable owner?
a 5MC ❑ 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 properly in question:Annually Assessed
praeal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name Imo _agee or••ntract s- -r
GA__ , % •&S 1 .0
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(number and street,city,state,and ZIP code) '
Does applicant own property in any If yes,what county? What Taxing District? Dra IS' (\NO• a^` :of deduction
other county (f/ i -
inIndiana? ❑Yes ❑No •.
A person is not entitled to this deduction unless the person has a balance on the per Car i /� •••ed in the county
recorder's office(including any home equity line of credit that is recorded in the cou: d l�O• • /�••
COUNTY Al.',... (•�.
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.
Signat (owner's full name) -�((�A"_ Date(month,day,year)
�residd�ddres of applicant(number and street,city tate, nd ZIP 4.e)
b-4(5q 5 902- / / . ,/
Person authorized by duly executed Power of Attorney or by IC 6-1.1-0.7 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.