HomeMy WebLinkAboutMortgage_McGraw (2) _sa STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
if.'',:I FOR DEDUCTION FROM ASSESSED VALUATION
' ', State Form 43709(R13 1 10-15)
Prescribed by Department of Local Government Finance 1
INSTRUCTIONS: e MatgcA
7b be filed in person or by mail I
Filing Oates: 1) Real Property.Must be completed and dated in the calendar year for whir the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property isA UG 2 ❑ f p inty Auditor
located on or before January 5 of the immediately succeeding calendar year. Q.2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county County Recorder
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is •• i
See revs Zs for additional instmcfio s and qualifications. - _ - - II! 4,'I►)l�°r
Applir t $ /�' '12—alt • S " • ' • I NTY AUDITOR
Record',/ / ! Cum
dd—/a o— Or/ A a7 692 oaf (io/G number /'/number .
value of real property as of Mortgage I Contract 1 •ebtedness unpaid as of Mortgage!Contract indebtedness n id as of . Is the applicant the sole
assessment data,amend year assessment date,current year date of application legal or equitable owner?
do U ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below: `ts property in question:Annually Assessed
IRI Real Property ❑ Mobile Home essed
777��� Mobue Home(IC 6-1.1-7)
Name of mortgagee or contract seller
c 0729
Address of mortgagee or contract seller(num ,end dYeet cry,state.and ZIP code) )))
Name of assignee wother owner or holder of age 0 "AC4/(1�� /�. 7
Address of assignee(number and street city,state,and ZIP code) l/"/C/// (/�//,
Does applicant own property in any I If yes,what county? Wnat Taxing District? Ras this deduction been requested If yes,state amount of deduction
other courtly on property iw
rent year? ❑
=rent Yes El No
---- --=_----•---- ==ie person has a balance on the person's mortgage or contract indebtedness that is recorded in the county if credit that is recorded in the county recorder's office)that is the basis for the deduction.
' Drawer NO
! te COUNTY AUDITOR
Card NO. ...91 h 20 20 20 20 20
County • Date(month,day,yea)
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
AAowner!contract buyer of the aforementioned property on date application is filed.
` re(owner's fun name) Date(month,day,year)
�Jzid) me nib
F resident aggress of applicant(number and street,city, .and ZIP code)
/!00(0 ,2JLv00d J� /SL ' Jn L( '-17& 70
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street city,slate,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.