HomeMy WebLinkAboutMortgage_MacMunn STATEMENT OF MORTGAGE OR CONTRACT INDEBTFNI~' I ice.
=a.: g� ' i1%7 j3 Township Year
Pil, FOR DEDUCTION FROM ASSESSED VALUATION
�•� State Form 43709(R13/10-15)
Prescribed by DepartmeM of Local Government Finance OCT 1. 1 •
File Mark
INSTRUCTIONS: ,r
Filing be Dates:in 1)rson Real by mail d"'y�11°" • IJiir Form filed with:
Filing Dates: i) Real FyopeRy:Must be completed and dated in the calendar year for which the �(i,
Must be filed or postmarked with the County Auditor or County Recorder ofappleyfir ve1(gt,¢tffi5)5,60 PR Ili County Auditor
located on or before January 5 of the immediately succeeding calendar ye ar ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County 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.
AppGrant(owner contract buyer- 7 msbt�ns on reverse 5ry)
Taxing District Key n mber/legal description Record number Page number
�. .r d /9 /6 /01 al C7 07a oo" ao i(0 @& 4
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of l Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment � • I
data of appgphon legal or equitable owner?
r•(/ I ❑ yes ❑ No
If in what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
tf name on record is different than that of appfant,indicate below Is the property in question:Annually Assessed
y]Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract set
�` % CCU
Address of mortgagee or contact seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage - - -
al-OII. - 000030 it 4P
Address of assignee(number and street city,slate,and ZIP code) . ,rriI. Cr H Nl io
t;V.Y4J30/I(t f4cAyr +
Does applicant am property in any If yes,what county? What Taxing District? Drawer NO of deduction
other county
In Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the f • I in the county
reconier's office(including any home equity line of credit that is recorded in the cc Card NO.
COUNTY A(.....a n%
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 correct and that the applicant is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is tiled.
S', - owners furl name) Date(will),day,year)
Full -".ent address of applicant(number and sheet city,state, ZIP code)
x 6873 S S . / XCt . Form- fn vlc,k, . y 76 V-.
Person authorized by duly executed Parer 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$10,000.