HomeMy WebLinkAboutMortgage_Nunez-Salemie x STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court -T i Year
•`'' FOR DEDUCTION FROM ASSESSED VALUATION
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��_ 1 State Form 43709(Ri3/10.15) 1 p � .
=� Presabed by Department of Local Government Finance 4 R�
INSTRUCTIONS: F 2t fjalk
To be filed in person or by mail. SEP 2 6 Form filed with:
Filing Oates: 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 pm.- t is. j AZ •linty Auditor
located on or before January 5 of the immediately succeeding calendar year. I ,is._
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Audi�tto.r,,Sof�fi aI 'Recorder
where the properly is located during the twelve(12)months before March 31 of each year the. @ao ••, /TY A
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) A
C' du°..a c 4 / •�a-C . Mi -y- -/�/ --
T District .. 11.ey number i legal description Record number Page numbe
71,x' girr -' ak - / 9- /8 - Soy- 000 . 771- od- C Zo/ fo 3 9K
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
Sr5 n 001), ❑ yes 0 N
If no,what is his I her exact share of interest? If owned with someone other than s
xa spouse,indicate with whom
If name on record is different than that of applicant,indicate belay. Is the property in question:Annually Assessed
❑Real Property ❑ AnnualyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller .- O Se .
Address of mortgagee or contract seller(number and street, ,state,and ZIP code) (,�1/t) /`l
Name of assignee or other owner or holder of mortgage g8' O""'/���fl�t1)�//l—��//t��(
Address o assignee(number and street city state,and ZIP code) ` Drawer N O v �'•r•••"f
as /a 9 /�7 Q �/�X� _
Does applicant own property in any If yes,what county? What Taxing District? Has this del \ .•f . /1•./ \•...
other count' on propa° Card NO. ...c.J ( Y 4J
in Indiana? ❑Yes ❑NO current yeas , - _
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 oh
20 20 20 20 20 20 20
4,......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 correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
l, Signature rrers tuff e) Date(month,day,year)
fX1 Full resident addddresss of applicant( umber and street,city,state,and z code)
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/Oil N Nµll S f off /Otc-ne4 hil VAi r
Person authorized by duly executed Power of Attorney or by IC 6-I.1-120.7 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.