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HomeMy WebLinkAboutMortgage_McCulley STATEMENT MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year r. �' FOR DEDUC OF TION FROM ASSESSED VALUATION State Fomh 43709(Ri3/7415) Prescribed by Department of Local Government Finance f' I 3 ©t INSTRUCTIONS: To be filed in person or by mail Form filed with: Filing Oates 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought p " Must be filed or postmarked with the County Auditor or County Recorder of the county where the propeny-isi3 L I I LI 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 Auditor of tth unfy where the properly is located during the twelve(12)months before Marc,31 of each year the dedu ,'irui See reverse side for additional instructions and qualifications. i . ^ fIRSOhI COUNTY AUDITOR App6ant(owner or contact buyer-see mstrgaru reve2e side) 94- d'.ezer. Taxing District Key number//legal description Record number Page number o -36 2o , - oo3.. 9,3a -oa / / (v 2197 Assessed ,<of real property:'-of (Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment• - current year I assessment date,current year date of application legal or equitah'e owner? 140.5,0 00 ❑ Yes ❑ No If no,what is his I her end share of interest? If owned with someone other than spouse,indicate with whom If name on record Is different than that of applicant,indicate belay. Is the property in question:Annually Assessed ❑ RealProperty ❑ Annually Assessed • Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller — — - ___ _ Address of mortgagee or contract seller(number and street.city,state,and ZIP code) Drawer NO.../ Name of assignee or other owner or holder of mortgage �(/.. '^••••••••... Address of assignee(number and street,city,state,and VP code) Card "2`^ Pr S F_ 3 Go - 2 -ia- a . 8Y3 o. ............ .... Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requesieu ton other re Indiana? ❑Yes ❑No current year? ❑Yes ❑No l A person is not entitled to this deduction unless the person has a balance on the person's mortgage or cenoact indebtedness that is recorded in the county 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 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 filed. Sig • on 1• -) Date(month,day,yeah ke n -/6 Full resident ad.--of app6ant umber and street,oily, ,and ZIP code) il025 5, 5k_ (9 S cDCt' C519C1L��1 A.9 l717/ 66 Person 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$10,000.