HomeMy WebLinkAboutMortgage_Bradley a* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Pats Form 43709(R12/ ent) ��
,•°;4„. Prescribed by Department of Local Government Finance
INSTRUCTIONS:
To be riled in person or by mail. 2 Form filed 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 .
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is • Linty Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ ounty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coug
where the property is located during the twelve(12)months before March 31 of each year the deduction is :TIN '11/1"171.4'11/1"17'11/1"171.4� �m
See reverse side for additional instructions and qualifications. - GI SON COL INTY AUDITOR
Appfica j(owner or conAct buyer-seeeisMdions verse side)
Avo..►'1 a �vGt r rn2l( SSG� �Ltg i c of/z
T Dis r� Key number/legal de tion <J R number G Page umbe
/ ��. Grp-I1-al —aOo -cx��{ • *195- dam niV �ous
Assessed val real property of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness u Was of Is the applicant the sole
March 1.amen y� March 1,current year date of appsc�epn g f' legal or equitable owner?
�7J 1..:�`C/.,.1'jJv - I// I�S g 1 ❑ Yes ❑ No
If ra,what is Its/her exact share of interest? It owned with someone ostler than spouse,indicate with whom
If name on record is different than that of applicant.indicate below Is the property in question:Annually Assessed
❑ Real Property ❑ AnnuallyAcsessed
Mobile Home(IC 6-1.1-7)
Nam of mOnga ee or ntr'yct seller •
Address of mortgagee or contact seter(number and str aty, ._,and ZIP code)
50 tiol C L Q-Co a, TYCO t 2..2 1 w j\/i t le 1 -r-N4 3-1 S1}—(
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in If yes.what county? What Taxing District? Has this deduction been requested If yes.state amount of deduction
other county on property for
in Indiana? 1.1)Yes No current year) ❑Yes ❑No
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 of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I l 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 owner's full name) Date(month,day,year)
�'/��I`^a'f'`-y'�y—xIacx -Z-l�1-( Co
Kull resident address applicant(nu ra/d street,cityet,city state,and ZIP code)
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 ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.