HomeMy WebLinkAboutMortgage_Phelps (5) • STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS hiP Year
FOR DEDUCTION FROM ASSESSED VALUATION
L State Form 43709(R13/10-15) —/ 2 017
•N<;',-, .0 Prescribed by Department of Local Government Finance
INSTRUCTIONS: SEP 2 6 20*Mark
7b be filed In person or by mail Form flied with:
Ong Dater 1) Real Property.Must be completed and dated In the calendar year for which the deduction Is sough
Must be Ned or postmarked with the County Auditor or County Recorder of the county where the 1,• r�--_trf1; 4.l■• County Auditor •
located on or before January 5 of the Immediately succeeding calendar year. I INTY A papQyunty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County laag toPE -
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 naefctlons on reverse aide)
Ch(, Stophef W. MnelPs g lima 3. Hid ps
Taxing District Kay number/legal desatpaon Record number Page number
26 - 12 -06 - 0.2 - 000 . 2)'-1 - 02S _ 01 Ca- (1or3C9
Messed yaks of red property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Centred Indebtedness unpaid as of Is the applicant the sole
assessment date,curare year assessment data current year date of application legal or°spi table owner?
4 16 S, I SO Ig Yes ❑ No
if no,what Is his I her exact sham of Interest? if owned with someone other than spouse,Indicate with whom
If name an recited Is different than that of applicant,Indlcata below is property In question:Amuafy Assessed
Rea)Property ❑ Annually Assessed
Mobile Home(IC 8.1.1-7) .
Name of mortgagee or mntrad seller
&eym&n Ameei ( an Q&zn(orp
Address of mortgagee or contrail saner(number and street oily,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street coy,stem,and ZIP code)
Does applicant own property In e/r9y If yes,what county? What Taxing District? oHas this deduction been requested If yes,state amount of deduction
�iaanna? ❑Yes LO N° on n yyar? ❑Yea 0 N
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 bi the county
recorders office(intruding any home equity line of credit that Is recorded In the county recorder's office)that is the bars for the deduction.
I COUNTY AUDITOR
Deduction approved N the amount of:
20 20 20 20_ 20 20_ 20
Signature of County Auditor County Data(month,day,yew)
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 dat application Is filed.
7 ^ Data(month,hey,year)°I Z I I 201G.
Ft
F rssidalit ad applicant(number and street ca):an P code)
IG greniwoocl be Princeton, IN 610
set authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Data(month,day,year)
Vdress of authorized person (number and street city,stem,and ZIP code)
he penalties for penury can Include Imprisonment up to two and a half years and a fine not to exceed 510,000.