HomeMy WebLinkAboutMortgage_Bottoms .� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
k-. FOR DEDUCTION FROM ASSESSED VALUATION -_-
-:,1,'-;,;�:` State Form 43709(R73/10.15)
SRicL f Prescribed by Department of Local Government Finance
i
INSTRUCTIONS: t art
lb be filed in person or by mail 1 fI'. `..
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought I r
Must be filed or postmarked with the CountyAudiitor or County Recorder of the county where the property is we
. • • J4l•r
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county CT I ❑ County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is so t •• •
See reverse additional instructions and qualifications.
Applicant(• Gbuyer rses�)// Qrt3$Q .
�� 9tt/lY)Lll N CO"'Nry
value I/1 CO �UdeunP number A�' ben
value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contra indebtedness unpaid as of Is the applicant the sole •
assessment date,current year assessment date,current year date of application legal or equitable owner?
D 2, /y y9 El yes 11 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 beta- - Is the property in question:Annually Assessed
❑ Real Property ❑ AnnuaflyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 3
Address of mortgagee or contract seller(number and t city,state,and Li bay-. ln�
�7- ecz/Of7•l/.-_____
Name of assignee or other owner or holder of mortgage [p 7i ((,
Address of assignee(number and street city,state,and VP code) Dra?vet- )\r O.... Q�/_......
�applicant own property in any If yes,what county? Mar Card No. y IX 5/ s,state amount of deduction
in Indiana? ❑yes El No .........
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract anoeuav...___.hat is recorded in the county
recorders 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 f 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.
X Signature( full name)`.ls Date(month,day,year)
I
FWI resident address of applicant(number and street city, code)
8x78 E- Sao S. like ) iN
Person authorized by duly executed Power of Attorney or by IC e-1.1-12.0.7 Date(month,day,year)
lki
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. .
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION g
Prescribed Farm 43709(R13/70.15) qL
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mad - D II ... ,!....Cp.
Firing Dates.' 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed orposbnarked with the CountyAuciItor or County Recorder of the county where the property is. • Q r•' 1Md • .
located on or before January 5 of the immediately succeeding calendar year. I I• T["rr+l't/Recorder
2) Mobile/Manufactured Homes not assessed as Real Property.Must Re with the r r rntyAuditor of the
where the property is boated during the twelve(12)months before March 31 of each year the dedudion is N t •• .. v a a •:
See reverse side for additional instructions and qualifications. ••
T Nat / desorption Record Page r
— al o -o?p-goo - ocO. 06‘- oo/ 070 . a7
Assesedyatue drawl property as of Mortgage/Contract indebtedness unpaid as of • Mortgage/Contract indebtedness unpaid as of Is the appt�rd the sole
assessined data,anent assessment date,amen(year date of app�tionn / "--�R�� legal or equitable owner?
❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than Asa,Indicate with whom •
If name on record is different than that of appennt,indicate below. is property In question:Annually Assessed
Real ❑ rap
Mobile Home
1.1-7)
Nam of mortgagee or contract seller
Address of mortgagee contra seller(number ee a contract city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage •
Address d assignee(number and street,ray,Vale,
Does ; /�j��� 9L . 21- 3- 9 /
Doer c that axing District? Has ideductio n been requested If yes,state amount of deduction
m udii r A in) A. 130 rr0 S arrant yeah far ❑yes ❑No
A perm 3 balance on the person's mortgage or contract indebtedness that is recorded in the county '
record( // recorded in the county recorder's office)that is the basis for the deduction.
I(,- 4,2 I COUNTY AUDITOR " • •
Deducti
20 20 20 20 20
Signature of CountyAObicr County Date(mania day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and erred and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
( Sigretafemert lull name) Date(month,day,year)
%' 1t" T Jt.40 4 .(>>o T-TD in_s
Fug resident address of applicant(number and street,city,state,and ZIP code)
e ( ? BE9DO3 PJ )3nvE=ei0. - -IL is.-7o / 3
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 say,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.