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HomeMy WebLinkAboutMortgage_Bridges (2) fiiay STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ip Year s FOR DEDUCTION FROM ASSESSED VALUATION ?'.�` State Form 43709(R13/10-15) S ., Prescribed by Department of Local Government Finance • INSTRUCTIONS: JUL 18 2046 Mark To be filed in person or by malt. Form filed with: Filing Dates 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is song • Must be filed or postmarked with the CountyAuditor or Courtly Recorder of the county where the p¢(ftµ{.(b, ❑ County Author located on or before January 5 of the immediately succeeding calendar year. ri cSoN COUNTY Al C©Q unry Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County u /two the county 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. Ap �qt(owner or contract buyer see restrictions on reverse side) r �SLe��a2ot a_er i T�ppq District Key number/legal description Record umber Page number - O A - Y9 - io/ - 000. / 5 / - o 9 7,E9 Assessed valu. of teat property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole assessment date,anent year assessment date,current year date of application legal or equitable owner? 3 5 o o 0 ❑ Yes 0 N II no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom II name on record is different than that of applicant,indicate bebw is the property in question:Annually Assessed ❑ Real Property ❑ Annually Assessed Mobile Horne(IC 6-1.1-7) Name of mortgagee or contract seller Address of mortgagee or contract seller(number and street cdy,sta and ZIP code) Name of assignee or otter owner or holder of mortgage Address 'ghee jpymber and street ate.,a code) R L D/'• 3 Do r.)AL 0 Does applicant own property i cry It yes,what county? What Taxing District? Has this deductio �1` l� 'gig C �iaana? ❑Yes ❑No currren`current I J _ A person is not entitled to this deduction unless the person has a balance on the person's mortgage or c /1, —)028 — recorders office(inducting any home equity line of credit that is recorded in the county recorder's office) 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. re(owners i . •.) I Date(min.dr,day,year) 7&° WI resident address of appficant(number- d- - and ZIP code) SC5 CA 51- Surma; St. I AZLt . iR4 y1&43 JPerson authorized by duly executed Power of Attorney or by IC 8-1.1-12-0.7 Date(month,day,year) Address of authorized person (number and sheet city,slate.and ZIP code) The penalties for perjury can include imprisonment up to two and a haff years and a fine not to exceed$10,001