HomeMy WebLinkAboutMortgage_Lashbrook STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
tm:
FOR DEDUCTION FROM ASSESSED VALUATION
Y State Form 43709(873110.15)
' Prescribed by Department of Local Government Finance
INSTRUCTIONS: !
tic
To be filed in person or by mail Fo ' fi with:
Filing Oates 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought r
Must be filed or postmarked with the County Auditor or County Recorder of the county where the is County Auditor
located on or before January 5 of the immediately succeeding calendar year. �'+ut !�
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the copy ZO 6 County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deductian is sought
See reverse side for additional instructions and quafrfications. ,N//
Apps h era n ct buyer- --urea on reverse . //` L518SONCOiCTAt UDITnp
Taxamg
Key lII, .._ /legal descd I //��/(„ -_..:.number Page num•-
r d� 3-o9 a300-�. l /9 DoW 02003 iv
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
nt date,current year assessment date,current year date of application ?? �/����)) legal or equitable owner?
ds:CO/ ❑ 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: Is the property in question:Annually Assessed
�r l Real Property ❑ Annually Assessed
• /` Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller �
.3
Address of mortgagee or contract seller(number and sheet,ray,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
(/l ) r__ -(0 f/�- /0
Address of assignee(number and sheet obi,state,and ZIP code) �!/ / 3 71C
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
in 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
recorders office(induding any horne_eouifv Fria n r...y---- in the county recorder's office)that is the basis for the deduction.
--- COUNTY AUDITOR
Deduction at
20 LIC263 20 20 20 20
Signature of C County • Date(month,day,year)
I/We cert Card NO. ............
� � ling information is true and correct and that the applicant is a resident of Indiana and
'�w owner/co ,,..ication is filed.
I Signer (own �� Date(month,day,year)
Frntl reessid+�ent address of flan?(number and sttreet cicity state,andd ZIPP cod
XP/? authorized by executed Parr ofAttorneyy or by IC e- .1-12.0..7+/�!`/Ts/6L/1` I Date(month,day,year)
Address of authorized person (number and sheet airy,state,and ZIP code)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000. .