HomeMy WebLinkAboutMortgage_Lewis x STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' -. FOR DEDUCTION FROM ASSESSED VALUATION
a' State Form 43709(R13110-15)
- Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. Font filed with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sough yg
Must be filed or postmarked with the County Ardrtor or County Recorder of the county where the rte s N r•• i Auditor
located on of before January 5 of the immediately succeeding calendar year �J :•r
2) Mobile/Manufactured Homes not assessed as Real Pro Recorder
Properly:Must file with the County Auditor of the county
where the properly is located during the twelve(12)months before March 31 of each year the deduction 14 hb ZQ 16
See reverse side for additional instructions and qualifications. ''tit
Appfican.ivneror contract buyer+-see restrictions on reverse side l,„ n,
■ ►� 1 + %� t • -f „Ai boQ- Xli
Taxing Di Key numbers legal description GifsSO^ic�p Page number
) 076- — 1 4- loo -cape 1307 DO I 070!/ AUCITOR 3 13 5
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of 444111 Is the apgaant the sole
assessment date,current year assessment date c nt year � I date of application legal or equitable owner?
I L r OZYZ) I ❑ Yes ❑ No
If no,what is his/her exact share of interest? I If owned with someone other than spouse,indicate with whom
If name on record is afferent than that of applicant,indicate bekwr. Is the property in question:Annually Assessed
❑ Real Properly ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
ale �.-r�Av� .M k /'1�Address of mortgagee or contact seller(numb� d stars, ZIP )��r `/1 —' .
Name of assignee or other owner or holder of mortgage N"Y1 Vt,, n r' (17 r ,.I. n l//) 4,^.
�./_+D Q 1 f.FCv.ALL 0cc�.)hY, s� -�ch0
Address of assignee(number and street thy,state and ZIP code) D ra SVC!' NO. c Oi Zp
. ..................
Does applicant own property in any If yes,what county? What Taxing District? ' !-� r� - deduction
i nndiana county 1..11'(1 1\10. - 0 1 3
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the perse e�n ) II .. .''•''''•• • 'n the county
recorders office(including any home equity line of credit that is recorded in the count) '4 (0{D,Co 103.
COUNTY AUDITOR -
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County - Data(month,day,year)
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 tied.
Signature( a--- Date(nnrntr,day,year)
Fryer • ent address of applicant(number and street oIy,state,and ZIP code)
Person authorized by duly executed Paver of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
•
The penalties for perjury can include imprisonment up to two and a hat years and a fine not to exceed$10,000.