HomeMy WebLinkAboutMortgage_Hedges S, STATEMENT OF MORTGAGE OR CONTRACT INDEBTE S C, ; Township Year
tit` ' FOR DEDUCTION FROM ASSESSED VALUATION t 1 is
State Form 43709(R13/10-15)
•"- -• Prescribed by Department of Local Government Finance 2 6 2.0\S INSTRUCTIONS: PUG File Mark
lb be filed in person or by mail. i adi Form filed with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the ded re-•, id -.4.-rim j OR
Must be filed or postmarked with the County Auditor or County Recorder of the cou ' I'. . : :•. •penyIS ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ,-N CO ❑ County Recorder
2) Mabee/Manufactured Homes not assessed as Real Property:Must We with targiMOiVe Auditor of the county
where the property is located during the twelve(12)months before Maid?31 of eao5 year the deduction is sought
See reverse side for additional instructions and qualification.
Apprram(omre(r3x fraogpuyer-seer on se sr1rJ 1 - -- - - - -T D V(JUC C_T11,V_Y\ Key number l legal description 01X{'(, J Record number Page number
L, a� - /a :/$ -/a5ao3 �s a 0 8' i6 3059
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment year date of application legal or equitable owner?
t) ❑ Yes ❑ No
If no,what is his 1 her exact sham of interest? If owned with someone other than spouse,indicate with whom
If name on record is deferent than that of applicant indicate below'. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
'•- Hoare(IC 6-1.1-7)
Name of mortgagee or d seller -
Address of mortgagee con ct seller(number and street dht state,and ZIP code) ----c ON
`
Name of assignee or other owner or holder of mortgage (Q 1 r�5q
Address of assignee(number and street,city,state,and LP code)
1 �,J
Does applicant own property in any If yes,what county? What Taxing District? ,_.,s-rate amount of deduction
other county •
in Indiana? ❑Yes 0 No _ .,a Li No
A person is not entitled to this deduction unless the person has a balance on the person's rgage or contract indebtedness that is recorded in the county
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 20
Signature of County Auditor County - Date(month,day,year)
•
e certify under the penalty of perjury that the above and foregoing information is true and conect and that the applicant is a resident of Indiana and
own-r I contract buyer of the aforementioned prop on date application is filed. ///
(.
jr> / //m t(n i and dty,state, Pcode) L/ , ef-<�
Person authorized by duly executed Power of Attorney or by C 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street ay,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a had years and a fine not to exceed S10,000.