HomeMy WebLinkAboutMortgage_Jarboe a„ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County F E Year
''` � FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
Presorted by Department of Local Government Finance
INSTRUCTIONS: FII-au
r
lb be filed in person or by mail. Forte it 7 '
Filing Dates 1) Real Property.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 ) 0. ,my,; ditor
located on or before January 5 of the immediately succeeding calendar year. nip ' ijj ,'lIMI,-ecorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the CountyAuditor of the co'tM SON • NTY • ,
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 coAnifrai i, - -z;r ion reverse�'ie(ej� fr QtjAAA- //
it lCey / descri (,.�• Record number Page number
Assessed value of real property as of 1 Mort gage l Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year I assessment date,current year data of application legal or equitable owner?
.07o o ❑ 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 different than that of applicant indicate below: Is the property in question:Annually Assessed
eal Property ❑ Annually Assessed
• Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(numbe and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage `I/) „/l J(L/ i / P U7•
Address of assignee(number and street city,state,and ZIP code) ���//(.q/// lam_(-,'('(/(r//
p What Taxing District? Has this deduction been requested If yes,state amount of deduction
<p O 3 C - 6 i ' T t - wrenp t yeary7 ❑Yes ❑No
h^ f r on has a balance on the person's mortgage or contract indebtedness that is recorded in the county
sTE PAi Ei) 179 t that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
l6 -3a 75"
20 20 20 20
Signature of County Auditor County Date(month,day,year)
I 1 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/contract buyer of the aforementioned property on date application is tiled.
Aigr a:isid me) / // Date(month,day,year)
Full r address`ofof app�d street,city,state,and LP code)
79s6.e. C/2,g // 42-1.4, -A t,1/ 4./-7 (t?
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 LP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.