HomeMy WebLinkAboutMortgage_Raney �, . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
`. -r FOR DEDUCTION FROM ASSESSED VALUATION
�'- State Form 43709(R13/10-15) I T
�--- Prescribed by Department of Local Government Finance 't -/ �'��JJ
INSTRUCTIONS: File Mark
R,be filed in person or by mail. S +dS',b
Filing Dates: 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed orposimariced with the County Auditor or County Recorder of the county where the property is ❑ County ' d' .
located on or before January 5 of the immediately succeeding calendar year. I i
C:/ Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the Courtly Avditor of the
where the property is located dining the Melte(12)months before March 31 of each year the deduction�N u ' - ' • - e
See m side for additional instructions and qu ens.
Ap t(owneror Qaa txryer-see 2 rse sxle)
,/�"- �
Taxing •Cle. _ nu /legal description R n r Page number
-A - �6- , 00- on/� D-2/ �" ,3953
• -- :..value.• it.,property•i Mortgage/Comma indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole
assessment dath,current year date of applicatbn/ _ /� legal or equitable owner?
bJ/7// ❑ Yes 0 N
If oil,what is his/her exact of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of ap below. Is property in question:Annually Assessed
Real Property ❑ AnnuatiyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(num and sleet ray,state.and ZIP )
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and LP code)
Does applicant own property in any If yes,what county? what Taxing District? Has this deduction been requested If yes,state amount of deduction
other county or ❑iana7 Yes El No curren 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/We certify under the penalty of perjury that the above and foregoinc:..r....t:nnk true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date applic 1 \ I 1 —--
Signature(owner's tuff name) W t Is `,^`r`r� \'
i 1^7\n, y day,yew)
F�resident address of a4• ant(numberlAiind street,city,state.and LP code) 'P--0"`r. e,`/ `O V �-V P.r>.•r•,5
-b _Scot - W 3co S A'le T u.,4..\- Qkei Wt,n,e. Loa,,,.s .
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 day,year)
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Address of authorized person (number and sheet city,state,and ZIP code) p-O I. —'l S -3 i— l— l(o
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000. .