HomeMy WebLinkAboutMortgage_Warren (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Togt)h Year
r' FOR DEDUCTION FROM ASSESSED VALUATION �tt�1
State Foram 43709(R13/10-15)
'sue Prescribed by Department of Local Government Finance 11
INSTRUCTIONS: JUL �l(i 'id6
lb be filed in person or by mail. Form sled with:
Filing Dates: 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the propertyi• • 111„ -•• Auditor
located on or bef ore January 5 of the immediately succeeding calendar year. . • -ihrlrfil 1 r
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor t�(gTOtt OU T'
Is II• •-corder
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.
A nt(owner or contract buyer- resbiiccct''ons on reverse side) _ td
T • g District _ V, number I legal d 'plion Record number Page number
o'lCP - I .7 -l2% . aoa, _ ovo . Lf 9O - oil 1 (0 1'-I3y
Assessed value of real property as of Mortgage!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?
1 14 tpOO ❑ Yes ❑ No
if no,what is Ms/her exact share of interest? If owned with someone other than spouse,indicate with whom
H name on record is different than that of applicant indicate below Is the property in question:Annually Assessed
❑ Real Property ❑ AnnuaI 'Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller e W^'
Address of mortgagee or contract seller(number and street dry,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(nuAber and street city,state,and LP code)
&-a- ) yY /7 �7--)E is - 3 -ir1 . i3os 4- C
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other on property for
Li Indiana? Yes ❑No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract 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
(JA2REU 57EP/aAure —
Signature of County Auditor County
SACKSL . Jk
I/We certify under the penalty of perjury that the above and foregoing information is true Lana and
owner!contract buyer of the aforementioned property on date application is filed. 14 — I q1/45c/re(owners full ram
k •_ r \.1hAnR,vim
ent address of app&znt(number and sheet d state,and ZIP cede) Jam,
' 03 C. 1fVlor�k9or�er\I S- . Oc ' Ifs .
d e��s 1
Person authorized by duly executed Power mey or by IC 1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet 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. .