HomeMy WebLinkAboutMortgage_Greene . STATEMENT OF MORTGAGE OR ttONTRACT INDEBTEDNESS County Township Year
zf -; : FOR DEDUCTION FROM ASSESSED VALUATION
'^",' 'r' State Form 43709(R13 110-15)
S Prescribed by Department of Local Government Finance �
INSTRUCTIONS: File Ma r
lb be filed in person or by mail. JUL IFe
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought '-"'u
Must be tiled or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of The immediately succeeding calendar year. • GI IF -..rder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the cou .1 • .i.I.rrlfjot
where the property is located during the twelve(12)months before March 31 of each year the deduct/latent OUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant( era( era niy or contact buyer re on reverse e�k�7e71'l`�')
Taxumg District �..Q.1 Key /legal desaiplion Record number Page number
0r3-f a.6 - 1� - lot- 4o`-l - odoAS1 - b,�a a o 14 1. t2
Assessed value of real property as of Mortgage I Contact indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or,equitable owner?n oa 64:Yes ❑ No
If no,what is his I her exact share of interest? - If owned with someone other than spouse,indicate with whom
If name on record is caferent than that of applicant,indicate below. t e property in question:Annually Assessed
Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name or contract seller (`�;
Address of mortga or contract seller(number and street city state.and ZIP code) —
Name of assignee or other owner or holder of mortgage 0
Address of assignee(number and street city,state,and ZIP code) DCDrawer O••"'"""
•er r/f�-r. •
Diller applicant o w n property in any If yes,what county? What
Ca-1-d N O'. ••' ••.••-If yes,state amount of deduction
in Indiana? ❑Yes '6(}tQo
A person is not entitled to Mr deduction unless the person has a bs -• _..—ye of deniract indebtedness that is recopied in the county
recorder's office(including any home equity line of credit that is ma -__0.um county recorders 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)
•
11 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 rutl n. •-) Date(month,day,year)
Fn _-rent address of applicant(number and street oil state,and ZIP code)
P.975- A. 4Ar4. Sy' // wo�titi i/t'r IL 47665
Person authorized by duly executed Power of Affirtcey or by ICS-1.1-1?-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$10,000.