HomeMy WebLinkAboutMortgage_Williamson x STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
17 FOR DEDUCTION FROM ASSESSED VALUATION ji.41 u t El)
State Fonn 43709(R13/10.15)-
S I Presrnbed by Department of Local Government Finance -
INSTRUCTIONS: OCT Fi) d
To be filed in person or by mail. orm =•with:
Filing Dates: 1) Real Property.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 props • ' . ' ditor
�' succeeding year. �' ' �� ' unty Recorder
located on or before January 5 of the immediately succeedi calendar
2) Mobile/Manufactured Homes
n r Page bet
o-moo/o l60 ��/. 7,1 _00/ I � 3 ?
eccnrt value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment ate,aurent year assessment date,current year date of appf op , legal or equitable owner?
<rr//U�( (/� ❑ yes 0 N
it no,what is his/her exact sham of interest? If owned with someone other[Jan spouse,indicate with whom
If name on record is different than that of applicant indicate below. Is e property in question:Annually Assessed
Real Property ❑ MnualyAssessed
/\ Noble Home(IC 6-11-7)
Name of mortgagee or contract seller ( ^/„ 0
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,cily,state,and ZIP 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
Indiana?
other county ❑Yes ❑No currenp�ty property for ❑Yes 0 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 Gne of aedit 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 t`-�`afit Lrr n �1c1r1 20 20 20
Signature of County Auditor 9)441-2-0-n r wlN"r I 7 my Date(month,day,year)
I/We certify under th / L�;�i ✓ n is true and correct and that the applicant is a resident of Indiana and '
A 1) owner l contract buys
Signature(owner's full nam�� Date(month,day,year)
1`
r i oesident address of applicant(number and street,city,state,and ZIP code)
9aC t cla C. 0Q!ha ul 67+y/till Al?E6o
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 city,state,and ZIP code)
The nalties for
pe perjury can i e imprisonment up to two and a half years and a fine not to exceed$10,000- _