HomeMy WebLinkAboutMortgage_Maxey (2) "I7:s?.r:' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
•�.:s FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
'4'.----"-L I Prescribed by Department of Local Government Finance FT . ,En
INSTRUCTIONS:
File Mark
lb be filed in person or by mail. OCT 4 F.N 'h_.with:
Filing Dater 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property' ❑ Court Auditor
located on or before January 5 of the immediately succeeding calendar)rear. IIIl.• -ipnl�if(County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor
where the property is located during the twelve(12)months before March 31 of each year the dede1d55i�#W.•' N– • - • : -
See reverse side for additional instructions and qualifications.
Applicant;' eror amtract cps'V-
T- side) c /�
Jr-0 do,- aacla/-61;2161-1:16,cp.
and value of read property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,amend, .'� assessment date,current year date of application /� I legal or❑ Yes ❑owner?
If no,what is his I her exact share of blterest? If owned with someone other than spouse,indicate with whom
tt name on record is different than that of applicant,indicate below. Is e property in question:Annually Assessed
Real Property ❑ AnnuallyAssessed
/// ��` Mobile Hoare(IC 6-1.1-7)
Name of mortgagee or contract seller Lie v.,3 t Q./
Address of mortgagee or contract seller(number and sheet city y,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street oby,state,and ZIP code)
Does applicant own prom 11 {[ Lf'�) Has this deduction been requested If yes,state amount of deduction
in�Inddiaanna?y ❑Yes 4 " i,tit ""� on t year? ❑Yes ❑No
A person is not entitled erson's mortgage or contract indebtedness that is recopied in the county
recorder's office(induct X10 ( ) wily recorder's office)that is the basis for the deduction.
Drawer NO - Cy , JDITOR
Deduchon approved in thr
- f Card NO. 39.78 . .
20 20 20 20
Signature of County Auditor County Date(month,day,year)
I 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
r/Contract buyer of aforementioned property on date application is fied-
II� Date(month,day,year)
applicant(n -her and•••-�,city and ZIP code)
1I iu1 'I u - r ( !T ,
Person authorized by duly executed •• •- of Attorney or I -12 .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 Iwo and a half years and a fine not to exceed$10,000. -
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