HomeMy WebLinkAboutMortgage_Sams (2) aezri STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.*f'-;Etc,.: FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13 110-15)
Ci- ' Presorted by Department of Local Government Finance F' I LED
INSTRUCTIONS: ����LLLL 1111
lb be filed in person or by mail. omm filed with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is soughtA u G 1 6 20
Must be filed or postmarked with the County Author or County Recorder of the county where the property is ❑ County Auditor
located on or be fore January 5 of the immediately succeeding calendar year. unry Recorder
2) where fe Manufactured is located Romedrat assessed as Real nths file 31 Meech yn tt ro/
whet tiinainsyisnsdquali the ions. (12)months before Mann 3f of each fill 71f TY AUDITOR
See/reverse side for additional instructio�nns,,and qualifications. /J ,/d w d /)
Taxing District Key number l legal description Record number Page number
�.° & — /Y -1 3002 - 000 . 04 �5'I/
po.�2.eer-� 8 - 5 7 3 -00 7
Assessed value of real papery of Mortgage/Contract Indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of I Is the applicant the sole
assessment dad,current year assessment date,currenntyear date of application - hgal or equitable owner?
`3300 r I ❑ Yes ID No
If rw,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is d u f e r e n t than that of a p p l i c a n t,indicate below: _ -
•
Name of mortgagee or contract seller �/� / D A US-0 nn 5A M S
Address of mortgagee or contract seller(number and sheet,city,state,and ZIP code) Am
Name of assignee or other owner or holder of mortgage /1/1£L—1- tic) S
Address of assignee(num and street,city,state,and ZIP Pwde)) r✓ f I y ,/�tL�L711//'1 ,4�e
Does applicant own property in a If yes,wh t counfJty?r what Taxing District? "��/ i"r / IJ'r_
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the pen. �J- �1
recorder's office(including any home equity line of credit that is recorded in the corn 't1 4 ^DO
COUNTY AUD f `J
Deduction approved in the amount of: DOCAE
20 20 20 20 1 1 — 513 ` I
Signature of County Auditor Cou Date(rcndm,L.
I/We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana.
owner I contract buyer of the aforementioned property on date application is filed.
tS".':,•eyyrf fun name) Date(month,day,year)
4j ,,, •.
fr
resid,, t•• of, font(number and sheet,dl state,and ZIP cope) / , /
3 i�"WaSh/n ton St- O8/(l2-d l l Ly _1// z/7660
Person authorized by duly exr�prtedaww of Attorney or by IC&1.1-12.0.7 / Date(month,day,year)
Address of authorized person (number and sheet 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.irn g n--1