HomeMy WebLinkAboutMortgage_Armes Jr a: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
r -4,1; FOR DEDUCTION FROM ASSESSED VALUATION
j`. State Form 43709(R13110.15)
`- Prescribed by Department of Local Government Finance II i ii iii.iii....
INSTRUCTIONS: , 1 e
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sougf.T q8 ❑
Must be filed or postmarked with the County Auditor or County Recorder of the county where the Isibce tpi Si;r County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of«l a coon County Recorder
-where the property is located during the txeAe(12)months before March 31 of each year the.;. +-•
See reverse : •: for additional instructions and qualifications. ��, rr q'nl�•
rIRcON COUNTY AUDITOR •
Ain,.= • �ct buyer-see re5 lipas use side)
T;.: • r., . Key tuber! Record number Page number
I Q �.- � - .3 -oao S�� - Q�7 a o l `i. ti s —1
value of rty as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applimm the sole
assessment dare,cu assessment date,current year date of legal or equitable owner?
�rwatarnn ❑ Yes ❑ No CCO
If rho,what is his/her of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is property in question:Annually Assessed
Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
'. ./,ill / t 4 _ —. _
Address of assignee(number and street city,state,and ZIP••• e /1 � ( r)
Des applicant own property in any If yes,what county? What Taxing District? HHi Has IW!nlJr cwt tU•-Cn) �� (-, III" n
in Indiana? ❑Yes ❑NO OM
I b—
A person is not entitled to This deduction unless the person has a balance on the person's me 'V my
recorder's office(including any home equity line of credit that is recorded in the county moon
COUNTY AUDITOR
Deduction approved in the amount at
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 coned and that the applicant is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is fled.
Signature ame) . Date(month,day,yea,)
i 1 _
RAI r—;•=.address of a o•,,.•= t(• and sheet state,and P e)
♦ c .S • a _/ t a' A—a Al e _ rswa - .0
Person authorized by duly execute•Power of Attorney or by IC 5-1.1-12-0.7 ' •. (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. -