HomeMy WebLinkAboutMortgage_Williams (2) °7) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS My Township Year
' FOR DEDUCTION FROM ASSESSED VALUATION 4
*.:i71:-..'..!:- State Form 43709(R13110-15) r
9�=l Presalbed by Department of Local Government Finance V 19t�'
INSTRUCTIONS: ` 2p1 File Mark
Ib be filed in perm or by mail 241 Form filed with:
FLJng Dates: 1) Real property.Must be completed and dated in the calendar year for which the urbon is sough
Must be filed or postmarked with the County Auditor or County Recorder of the county whe : thf.y.perry is Q❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. !lint.," ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the •rf •(' t.,".Q(tm.00un
where the properly is located during the twelve(12)months before March 31 of.,-4 :-.2r--�Prsuclion is sought.
See reverse side for additional instructions and qualifications. GIB
Applicant(owner or.. ba• - re�f. side)
Ii. L f I ii" /ft i4i
Tor number
a
p2110,u ( sSao ® /3a9 0/6) Page
Assessed value of real 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 dpt�ainent year date of application legal or equitable owners
5 /rat ❑ yes ❑ No
If no,what is his/her exact share of int st? If owned with someone other than spouse,indicate with whom
If name on record is different than that of app t,indicate below: Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortga�-// contract seller
—Address of mortgagee or contract seder(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
'A idress of assignee(number and street,ally,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? I Has this deduction been=_•-• - e amount of deduction
other county
in Indiana? ❑ u...
Yes ❑No —
A person is not entitled to this deduction unless the person has a balance o ____._--------- ecorded in the county
recorder's office(including any home '
( ng y equity line of credit that is recorded in lion.
Coup g6/ ...
Deduction approved in the amount ot:
Drawer l' ....•..
Dr. r''�
20 20 20 20_ y�,K.. 20
Card NO •••••
Signature of County Auditor I Date(month,day,year)
• I
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.
Sid re(owneYS,ful name) Date(month,day,year)
} rYp pia aQlLQ/rnv,
Full resided address of appfoant(number And city Sam,and ZIP code)
?7,93341 S aa5& •y h ivQ7(1 ter
Person authorized by duty executed Power of Attorney or by 1C 8-1.1-12-0.7 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.