HomeMy WebLinkAboutMortgage_Thacker (3) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T Year
t' a FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13110-15)
Presadfed by Department of Local Government Finance =Count INSTRUCTIONS:
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To be filed in person or by mail. Form in with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought JU� ,� �¢ouMy Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the •
where the property is located during the twelve(12)months before March 31 of each year the detOj See reve . .de for additional instructions and qualifications.
COUNTyq()p)TOR
Aspics t *wiles'or contract• r - -on reverse side)
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Taring Key nu I legal description Record number Page number
2t� f 0? - /77 3-•ao- Jac - y3QO. 29c4-00 9 a u 1 to aRaC,
•ssessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,cement year assessment date,current year date of application legal or equitable owner/
/07 3/0 ❑ Yes ❑ No
It co,what is his/her exact sham of interest? If awned with someone other than spouse,indicate with whom
If name on record is different than that of applic ant indicate below Its property in question:Annually Assessed
Real Property ❑ Annually Assessed
YY Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and sheet city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
a is Air l -- / — — -
Address of assignee(number and street city,state,and ZIP code) a C)\( _ -')-!
Does applicant own property in any If yes,what county? What Taxing District? Has this di \164v-dti 1 • `` c .C u
Wier county on pmpert
in Indiana? ❑Yes ❑No current ya t t\c-3
O O C1 • ( -1
A person is not entitled to this deduction unless the person has a balance on the person's mortgag r nfy
recorder's office(including any home equity fine of credit that is recorded in the county recorder's i , (S_
COUNTY AUDITOR �e
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/ r d buyer of the mentioned property on date application is filed.
Signaaure • ..••dF�a � Date(month,day,year)
77.,-/2044
Full r.- .�t address of app t(number and street city,state,and ZIP code)
/572_ S e C4'r /`f-n'm s r rGr-/v- ar 74'35
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Data(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.