HomeMy WebLinkAboutMortgage_Roudebush (2) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Townshi Year
f t FOR DEDUCTION FROM ASSESSED VALUATION p
ry'. State Form 43709(813110.15) Illi
Prescnbed by Department of Local Government Finance
INSTRUCTIONS: File Mark
lb be Ned in person or by mail. tn�,,\\Cj 9 Form filed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the d on is sought
Must be Ned or postmarked with the County Auditor or County Recorder of the county where ye r..:•-rty is ' [ County Auditor
located on or before January 5 of the immediately succeeding calendar year. VIRl" 1S OR
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the i s• r irc • tfr�unty County Recorder
where the property is located during the twelve(12)months before Marti 31 of e-D. �.=-'" -4 is sought
See reverse side for additional instructions and qualifications. GO s•Applicant do or •ct buyer-see reverse )
*At"- • 1/4f) gli
Taxing D'-•/, Key nu /(egad description Record number Page number
110-/oYh - tiv co5. 30�����1{{{iii aa/ /6 yao2 4`
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of I Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year I date of application legal or equitable owner?
79JO31 ❑ Yes 0 N
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
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgag contract s _
u
Address of mortgagee or contract seller( and street,city,state,and ZIP code) - -
Name of assignee or other owner or holder of mortgage \ �� 1-
--S Ro Y
Address of assignee(number and street,city,state,and ZIP code) O��U-- 1 �f � .t�
Does applicant own property in any If yes,what county? what Taxing District? • -TJ f deduction
Wier county l 6 ..t
in Indiana? ❑ 4
Yes El
A person is not entitled to this deduction unless the person has a balance on The pert a0` 1 the county
recorder's office(including an•home equity line of credit that is recorded in the county c-,� l 1 oO
COUNTY AUDIT
Deduction approved in the amount of 4- �-� - `S
20 20 20 20 20 20 20
Signature of County Auditor County • Date(march,day,year)
I/We --miry 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
own 'intact of ntioned property on date application is filed.
Sig awe - •r Date(month,day.Year)
Full i•e�l dress of ((number and state and ZIP code)
y17re �5 `nom / uS 5
auth ed by duty executed Power of Attorney or by IC 5-1.1-12-0.7 Data(month,day,year)
Address of authorized person (number and street city,state,and LP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000. ....... - -- .
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