HomeMy WebLinkAboutMortgage_Shearer (2) a.; . STATEMENT OF MORTGAGE OR CONTRACT IND1S '�.1` Township Year
,, _ , FOR DEDUCTION FROM ASSESSED VALUATION • it
�'. State Form 43709(R13!10-15)
Prescribed by Department of Local Government Finance
SEP 6 File Mark -
INSTRUCTIONS:
lb be filed in person or by mail. Form filed with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the ,-, .'•::..;,
Must be filed or postmarked with the CountyAuddor or County Recorder of the ?'.A wi i • is >4 County Auditor
located on or before January 5 of the immediately succeeding calendaf j9L.D N C• ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see residionons on reverse side)
1 ho rna9 5hect re r
T g District .1p Key number!legal desaipba,(1r rv�� �'Y�'�� Rewd number Page number
ra
Assessed value of t d W T prbpeny as of a to-t6 Mortgage 7 Ors indebtedness unpaid as of OMOrt 9/Contract indebtedness unpaid 01/ 40, applicant 368/
assessment date,current year assessment date,current year date of application legal or equfable owner?
X37360 ❑ Yes 0 N
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 different than that of applicant indicate below. Is the property in question:Annually Assessed
J, Yeal Property ❑ AnnualyAssessed
Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller
C7err or1 A (Yter1cgr.
Address of mortgagee or contract setter(number and street d(state.and ZIP code) _
Name of assignee or other owner or holder of mortgage /
Address of assignee(number and street city.state,and ZIP code) Drawer NO o201.C-4
—
Does applicant own property in any If yes,what county? What Taxing District? Has this d Si —
other county on Per
in Indiana? ❑Yes ❑No .current ye Lai l'd NO.
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or annum.. --__
recorders office(including any home equity the 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 Data(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner 1 contract buyer of the aforementioned property on date application is filed.
SignaNre ���^ / Daleq(momh/.day,yam
F em ad of applicant(number and aTy,state,and ZIP code)
Person authorized by duty 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. .