HomeMy WebLinkAboutMortgage_Bradshaw (4) ata STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
AF‘!'';''''': FOR DEDUCTION FROM ASSESSED VALUATION
�' State Form 43709(R13110-15) ■
Prescribed by Department of Local Government Finance DULYIEIEJFQR A�l1)
Subject to final acce£ f&r transfer
INSTRUCTIONS:
7b be filed in person or by mail. _day of �Ilf ivar,.
Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmadced with the County Aruor County
pecordeerrooffthe county whe•; e pm.4 i11 Dl County Auditor
located on or before January 5 of the immediately ,l, S1I fit•, fig Qv Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County •)•l r• •a, .•• 9 %f:••nuW rag
where the property is located during the twelve(12)months before March 31 of each year the dedt frt$FeabbaD U NTY A:JD ITO I:
See reverse side for additional instructions and qualIficafions. arse
Applicant(ownernon fact buyer-see reriorm on reverse side)16 (�(� •�
Taxinglpp• • 'kef'number/legal desahpwn Record number Page number
'V VP a(et — ly — n - 1 h)--C)00 . l96-1 -on 7 aDILit 3`fbS
Assessed vahre of real property as of Mortgage I Contact indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of f Is the applicant the sole
assessment date,current year assessment date,current year date of application I legal oreequitabe owner?
I lo r t) D h Nafes ❑ No
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 S different than that of applicant indicate below: I.syne property in question:Annually Assessed
c^ ❑ Annually Assessed
' _ Mobile Home(IC 6-1.1-7)
-
Nam oF;1 mortgagee or contract sell _ \ (1y •••
l Y{X12 a.rTh j. -.IPA.-O Xa r JCs.C� ()_0\U
Address of mortgagee or contract seller(number and street city,state,and ZIP cc N Q,• ••'•••...;
pt1„c, t �6L
Name of assignee or other owner or holder of mortgage
Call d Nit• .,,..
Address of assignee(number and street,city,state,and ZIP code) -
Does applicant own property in any If yes,what county? what Taxing Di ,rcauctionnbee�en requested If yes,state amount of deduction
other county Iap�
in for
Indiana? Yes 'o current year? 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or co indebtedness that is recorded in the county
recorders office(including any home equity line of aedit 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)
I 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 bled.
Signature(owner me) la Date(month,day,year)
Fh9 resident ad&ess of app6ant(number and street aly,state,and ZIP code)
alai I.J. Mater S•F• Oaf{/ And L'�, H9660
P authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 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 510,000. .
sSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township ' Year
r.� • FOR DEDUCTION FROM ASSESSED VALUATION
'.'S State Form 43709(R13(10-15)
Prescribed by Department of Local Government Finance / y'�
INSTRUCTIONS: F�;- Ma��,,t
lb be filed in person or by mail •[flitted
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought ��11 �pu
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property i5A UG ' CoL Auditor
located on or before January 5 of the immediately succeeding
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coun my Recorder
ere the property is located during the twelve(12)months before March 31 of each year the deduction is -• •rt
See reverse side additional instructions and qualifications. i•- '�' is
Appbcant( er contaGbuye �on rsesMe)rsesrde> GtESONCOuN!'YgUDITOR cssiA
I,031
Kel' 14741-773°20 Record mum Page nu r
63 76 r
Assessed property as of ortgage/Contract indebtedness unpaid as of Mortgage/ indebtedness unpaid as of Is the applicant the sole
anent assessment year sessment date,anent year date of a ton legal or equitable owner?
❑ yes ❑ No
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 afferent than that of applicant indicate below. Is property in question:Annually Assessed
Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
�e2/17 ��
Address of mortgagee or contract seller(nu r�r�d abcet city,state.and P code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
/9-02 _ 2 2 rho2,qc
Does applicant own property in any If yes,what county? What Taxing Distill? Has this deduction been requested If yes,state amount of deduction
n ? property for ❑imIndiana ❑Yes ❑No current year? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage 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 ot.
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
�1�(fJ owner/contact buyer of the aforementioned property on date application is filed.
l- Signature( 74tuB name) •��l Date(month,day,year) I``-Yn
F es• rtl of I{p6c Aria. ..street •• abC_QD ge—cP1 — / •
on authorized by duly executed Power• Attorney or• IC 6-1.1- -0.7 (month,day,y1380
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.
•