HomeMy WebLinkAboutMortgage_Elpers (28) ,—;e STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
` _; FOR DEDUCTION FROM ASSESSED VALUATION
i. State Fonn 43709(R131 10-15)
FILE
' Prescnbed by Department of Local Government Finance
LVSTRUCTIONS: File Mark
lb be filed in person or by mail. JU . 1 :.) ? :
Filing Dater 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought County 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 ■4-.•a; Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county Winn.
where the pmpetty is located during the twelve(12)months before March 31 of each year the deductior139 St1 C• II ' - • a a • •
See reverse side for additional instructions and quaffications.
Applicant(owner or contract buyer-see restrictions on reverse side)
V__Q : it:� $ svL,e � 8,_161_,Q mot. _
Taxing s , Key number/legal description Record number Page number
1- � . sat , QC, -c) • 1.c - ti.Dc - cnI _ .,4tr- ori `I aot I Fsy9
•' =•value of real property as of Mortgage/Contract ind ness unpaid as of 4 Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
v date,aurem year )']oT assessment date,current year I date of appli ation legal or ifable owner?
bn Yes ❑ No
If no,what is his I her exact share of interest? -I If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below Is the property in question:Annually Assessed
(teal Property ❑ AnnualyAssessed
• Mobile Home(IC 6-1.1-7)
Name set
aame of mortgagee or contcontra ra
9 e in+r 9
Address of mortga9$ seller and street t and ZIP code) JfJL�
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
/ ■
Does applicant own property in any If yes,what county? What Taxing District? Has this deify--- 51‘‘' A"c.
I.,I�Miiaana?y ❑Yes ❑No arrr ,Cl— ■ {A a
k. u4 �1
A person is not entitled to this deduction unless the person has a balance on the person's mt. (_
)5' I .me county
recorder's office(including any home equity line of credit that is recorded in the county record( Ci .
COUNTY AUDITOR
Deduction approved in the amount of
•
20 20 20 20 20_ I 20 20
Signature of County Auditor County Data(month,day,yea)
•
I/We certify under the penalty of perjury that the above and foregoing information is love 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 - (owners ful name) Date(month,day,year)
.I .t _41?.......—, 1. '
resident address of applicant '• tuber and street aty,state,arid ZIP cod
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 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 510,000. •