HomeMy WebLinkAboutMortgage_Norman (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBIS
s_. �Cnty Township Year
FOR DEDUCTION FROM ASSESSED VALUATION B�/U
State Form 43709(1913/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: SEP 2 9 2016 File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the :f• l's -y;
Must be filed or postmarked with the County Auditor or County Recorder of th-411;do 121.11''-properly is County Auditor
located on or before January 5 of the immediately succeeding calendar year. rn-�INTY AUDITOR County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property.Must fig�4A111(ldonty'Auditor of the county
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 restrictions buyer-see restricti onnrreverse side)
5,t,e.en7 D /Y D'l
TS:iiistrict Key number/legal deswipton Record number Page number
t Z6- /I o/-'Y66 6o 't/ 4: // oar IC 3969
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,anent year assessment date,current year date of application legal or equitable owner?
/CO O CO ❑ Yes ❑ No
If no,what is his I 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 belay. Is the property in question:Annually Assessed
1®Real Property ❑ Annually Assessed
' Mobue Home(IC 6-1.1-7)
Name of mortgagee or contract seller.,TE
street
Address of mortgagee or contact seller(number and city state,and ZIP code)
— ORmap STE✓b� 0
Name of assignee w other owner w h o l d e r mortgage Ai
•
Address of assignee(number and street,dry,state,and VP code) 1 _ Z,` /
•
Does applicant own property in any If yes,what county? What Taxing District? I `,J `( 1 p duction
other county
in Indiana? ❑Yes 0 N
A person is not entitled to this deduction unless the person has a balance on the perm; _le county
reamder's office(including any home equity line of credit that is recorded in the county, ..__. __...,.,.r I,ar u ure oasis 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/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 filed.
Si,csatureeZnnam Date(month,day,year)
F address of applicant(number and sheet dty,state,and ZIP code)
' S9dt-( w old P( ,n(et� Rd , Ou -,so: I/c it,' 97CoC0 S
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street dry,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.