HomeMy WebLinkAboutMortgage_Waggoner �,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County F' ITI .,,Year
• FOR DEDUCTION FROM ASSESSED VALUATION ��1 State Form 43709(R13/10-15)
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r- Prescribed by Department of Local Government Finance
INSTRUCTIONS: iflYtII I r
To be filed in person or by mail. Form filed with:
Ring Dates: 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is , ■.! . ii -„•1 t
located on or before January 5 of the immediately succeeding calendar year. �ff aa ' 7 Im P' epp
2) Mobile/Manufactured Homes not assessed as Real Properly Must file with the County Auditor of the�bvl5PN C 0 ;. • �•.. •1j j�I Urder
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought R
See reverse side for additional instructions and qualifications.
Appfrant(Mae ror rrnfrart M,.,or-03e - , .;,.on reverse side) ` ,
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Tam u`�A�J 71 number I legal description Record number Page number
G a6 - ti-tt-So`l -bibo.oLA o- oat cub ILo ,39'K.,. •
Assessed value of real properly as old, Mortgage I Contract indebtedness unpaid as of Mortgage r Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year �r date of application legal or re owner?
( b•S) 10 lU 4r 'es 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 belay the property in question:Annually Assessed
btif Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
N of mortgagee or con liar 1
--�--+
Add of of mortgagee or contract seller(number and city,state, LP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction n been r4--------'
in Indiana? ❑Yes ❑No lcurrreni .\t"'� p
A perm is not entitled to this deduction unless the person has a balance on the person's mod& ,) A _(0 ((--// ? jm 1`1y
recorder's office(including any home equity line of credit that is recorded in the county recorder v
COUNTY AUDITOR
-- -
0
_____I Deduction approved in the amount of �
20 20 20 20 20 I 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 filed.
.1v., -- (owrers e) Dale(month,day,year)
• 4 00'/30/20/0
F ,1-- .em ... ., of t(number and street ay,state,and ZIP code)
•21V S rn4cfl 54, Ottik And CL'<yf TN Y?66o
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.