HomeMy WebLinkAboutMortgage_Glispie St STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'' - FOR DEDUCTION FROM ASSESSED VALUATION
r=` 1. State Form 43709(R73/10-15)
Prescribed by Deparhnent of Local Government Finance IF I
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teilErP
NSTRUCTIONS:
To be filed in person or by mart F led with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought S E P 2 0 2096
Must be filed or posbnarlced with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediatery succeeding calendar year. � odty Recorder•
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the®l4dtic tjsr
where the properly is located during the twelve(12)months before March 31 of each year the dgdq 9V ifiseitg5NTY AUDITOR
See reverse side for additional instructions and qualifications.
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Ap (owner or contract buyer-see restrictions on reverse side)'
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Taxing District Key number/legal description Record number Page number
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Assessed value of real property of Mortgage I Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment data,arrant year assessment date,current year date of aophoebon legal or equitable owner?
103 Do ❑ 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 di ferent than that of applicant,indicate below Is thdpropaty in question:Annually Assessed
❑ Rea)Property ❑ AnnualyMtescrd
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sel — — _ __Address of mortgagee or contact seller(number and street city,sate,and ZIP code) nl M\ QA.\\C
C� •��a. ISP1e °_
Name of assignee or other ovmer or holder of mortgage w t11\CV. 11 s e ll -4-6
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Address of assignee(number and street city,state,and ZIP code)2s/a ' aka Az l- / 8 " 1 C i 4 .o o � �°
Does applicant own properly in any If yes,what county? What Taxing District? Has th
other
in Z l•-•((e
iana? ❑Yes ❑No anent yeaar?r ❑Yes D No I
A person is not entIled 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 recorders office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
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Signature of County Auditor County Date(month,day,year)
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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 tiled.
` _Sig -, -(• net's full name) f Date(month,day,year)
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Full r - address of t(number and-% 1dty,state, - •ZIP code)
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Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0. Date(month,day,year)
Address of authorized person (number and sheet city,state,and ZIP code)
The penalties for perjury can include imprisonment up to Iwo and a half years and a fine not to exceed$10,000.
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