HomeMy WebLinkAboutMortgage_Harris (2) �,,,.kr STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Courtly Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
'. 1'� State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance F
INSTRUCTIONS: File Mark
lb be filed in person or by mail A UG °S`ngtf96nt1:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought County Auditor
Must be Ned or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the immediately succeeding calendar year. ecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must We with the County Auditor of e coup
where the property is located during the twelve(12)months before March 31 of each year the ded a SOU TY AUDITOR
See reverse side for additional
tom add itional iinstructions and qu alifications.
A°ti" r unua traVW aevekr A , , '797) t thiC
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Tamg D.-.:• Key /legal description Record number Page number
dr c c go-A5:070$ . 07a- ate 6/6 (-42 9a?
Assessed :I of real p.,-sty is of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
date,current ear assessment doe,current year - date of application legal or equitable owner?
Cil/ o�(j� ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse, with whom
If name on record is different than that of applicant,indicate bebw: Is e property in question:Annually Assessed
I�(J Real Property ❑ lly Assessed
Mobile
Mobile Home(IC 6r1.1-7)
Name of mortgagee or contract seller l
J
Address of mortgagee or contract seller(number and sheet city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage ///'''���
Address of assignee(number and street Sy, ro
state,and ZIP code) �� ^ /..,- S- /v /
county? Taxing 6 V�
Does applicant own property in any If yes,what unty? What Tag District? Has this deduction been requested If yes,state amount of deduction
otter on property for
in Indiana?_. Yes ❑No current year? ❑Yes ❑No
A person i ---tec the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder': I-1 2 r5 /1 "-''----orded in the county recorder's office)that is the basis for the deduction.
0(d4R_D hi COUNTY AUDITOR
Ded"ma OR LEARiC
20 20 20 20 20
i —A7a9
Signatui County - Date(month,day.year)
I/We certify under the penalty of perjury that me a.,...,._.._.bregoing information is true and coned and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
A SignaN ruff name) 1 Data(month,day,year)
.1-62 i 42-2.---t--.
!` Full resident address of applicant(number and sheet state,and ZIP code)
695 S, s--[41"e f 57 7274 c,Gcj_ 'Ai 4/7o5/
Person authorized by duty executed Power of Attorney or by IC e-1.1-12-01 Date(month,day,year)
Address of authorized person (number and street thy,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.