HomeMy WebLinkAboutMortgage_Meece (2) r"s r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION E l,)
Stater Form 43709(R73/10.15)
Prescribed by Department of Local Government Finance I
INSTRUCTIONS: File Mark
lb be filed in person or by mail. SEP 28 20t6TI edvAn:
Ring Dates: 1) Real Property Must be completed and dated in the calendar year for whidi the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the proper((NN is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. (��'(1??�'' unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Aud��oorr of th��Vl
where the properly is located during the twehe(12)months before March 31 of each year the W..66Jbii024 }TY AUDITOR
See reverse side for additional instructions and qualifications.
Ap i err or con ct buyer -s verse side) A
Taxing District Key number I description n ber a numbe
(9c0- 1- co- you -coo- vlioo
s 7
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appllcont the sole
assessment date,current year assessment currenntt year date of application legal or equitable owner?
S-7 (373 ) ❑ Yes ❑ No
If no,what is his/her exact share of interest? 6 If owned with someone other than 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
Address of mortgagee or contract seller(number and street city,state.and ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city------
Does applicant awn property in any If yes, - uction been requested If yes,state amount of deduction
other ❑Yes ❑No Drawer NO �0/ / ? ❑Yes ❑No
A person is not entitled to this deduction or contract indebtedness that is recorded in the county
recorder's office(induding any home ec : R Tice)that is the basis for the deduction. ,
Card NO J
Deduction approved in the amount of - .
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
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 filed.
Signature full name) Date(month,day.Year)
�yaf�Q�0� �.
F address of appfoant(number and street,city,staff,and LP Code)
3 36 ( SouTh 57 DA-X1,4,441 e.rr•1 , s,4/ it?44d
P authorized by duly executed Power ofAttomey or by IC 0.t.1-1211.7 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. .