HomeMy WebLinkAboutMortgage_Michel 'r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION T g�
?' State Form 43709(R131 10.15) ILJ .Si
Presalbed by Department of Local Government Finance �-�/ i
INSTRUCTIONS: File Mark
To be filed in person or by mail. AUG 5 21.. filedwith:
Filing Dates- 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Aud for or County Recorder of the county where the pm rty is • County Auditor
located on or before January 5 of the immediately succeeding calendar year. ' -4 •'
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Au•-•. .f •- :� •�r>nl�n� County Recorder I
where the property is located during the twelve(12)months before March 31 of each year th-.V •i. g t...e WY - • i --• -
See reverse side for additional instructions and qualifications.
/WW"-rant(owner or-42.4 buyer + 4 reverse side r 4 )� ,, Q
l/,Jtrict c-42 W IY V CMG
Taxing District Key number l legal description Record number Page number
_ a _/ 7 - /(0 - ro0 - ooh. / 6; 7- 0 -1- / ao/ a 393'
Assessed _ f real p••- of Mortgage t Contract indebtedness unpaid as of Mortgage 1 Contract indebtedness unpaid as of Is the applicant the sole
assessment...,/current y•-••` assessment date,current year date of application legal or equitable owner?
'7 0, 0 0 0 ❑ Yes ❑ No
If no,what is his I 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
❑ Real PropenY ❑ Mobile Assessed
_ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller - -
Address of mortgagee or contract seller(numb street city,state,and ZIP code) - -
Name of assignee or other owner or holder of mortgage W`O
Address of assignee(number and street,city,state,and LP code) Dt a)5'Ul• NO �, tom• �ar V`�U
_IT F.) to N (.t) I (P - 3 -/ a- / L 13-1S- IC
0... .9(-J..... •
Does applicant own property in any If yes,what county? .What Taxing District? Has this r'a I- 1\rO• ,�^C�
in Indiana? ❑Yes ❑No ,currrent year, —d ...,0. `S 1 •
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtednes,...-..••'•'.••••. rty
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction. ,
COUNTY AUDITOR
• Deduction approved in the amount of
20 20 20 20 20 20 4 20
Signature of County Auditor County - Date(month,day,year)
SI 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-
Sig re(ow MI name) ��7 Date(month,day,year)
/resent addre so i �. �_er n .r eA
resident address of app(zarrt(number and street city,state,and ZIP e)
lCallii/ hl s2 /&S Flt ille Tf1 jell(C&S
Person authorized by duty executed Power 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 half years and a fine not to exceed$10,000.