HomeMy WebLinkAboutMortgage_Jamir STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS -VMy Township Year
Ail'Sf FOR DEDUCTION FROM ASSESSED VALUATION V\I\�,. State Form 43709(R13/10-15)
Presaibed by Department of Local Government Finance ,i'
To be filed in person or by mad. .1\\\C \- �0�6 Files fledwnh
Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the tlbdkin is soug .
Must be filed or postmarked with the County Author or County Recorder of the county where brit'-14 4139. County Auditor
located on or before January 5 of the immediately succeeding calendar year. 40 k$ ' ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the ti •:::V the county
:.
where the property is located during the twelve(12)months before March 31 of each , cr0 :-.uction is sought
See reverse side for additional instructions and qualifications. •-Vi3S.
Applicen (owner or con ct r-see restrictions on reveRgside) -
Taxing D- Key number r legal description latine4 Record nu r Page morn
a , i�1/42-62 - /03-cc 7 / 0 _ 33 b
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
79 / 7 7 Dyes 0 N
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
( ea)Property ❑ Annually Assessed
Mobile Hoare(IC 6-11-7)
Name of mortgagll�
Address of mortgagee or contact seller(number and ste 1.tsoedee.2.in 710..•.e' ,M-'-�,.,,.�,.` _ _
Name of assignee or other owner or holder of mortgage
:tip
V�/)(�
Address of assignee(number and street,city state,and D t'a 1Y C t' NO a0
Does applicant own property in any If yes,what count • ' .3QJ„ aen requested If yes,state amount of deduction
other county Card NO. S-' I�L.Y
in Indiana? ❑Yes ❑No Yes ❑No
A person is not entitled to this deduction unless MI QD dell Q 177. ract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit mat is recomea in me coumy reamer a uu,n.cr unit is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County - Date(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 filed.
Sig t ( full name) Date(month,day,year)
1. li �� alp KAY. aiti
reside address of • — umber and aty�s� and L e)
> nillo C4 (AV 3A1 On- • v l,fiL UtXv3
Person authorized by duly 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.