HomeMy WebLinkAboutMortgage_Hallam } STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
., '-=k FOR DEDUCTION FROM ASSESSED VALUATION �,
• ?' State Form 43709(R13/10-15)
1
�• - Prescribed by Department of Local Government Finance
INSTRUCTIONS: File�M�a7rkq ��
To be filed in person or by mall. XI rrkd4rith '16
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 properly is IN Co�ty •Fi
located on or before January 5 of the immediately succeeding calendar year Ir. :ri ir7fil..rder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county- Ty AUDITOR
where the property is located during the twelve(12)months before Maid?31 of each year the deduction is soQIBS COUbI
See reverse side for additional instructions and qualifications.
•
• t er or ct -see on reve
b �� �t�a. X111.40
Tam. / Key u /legal dew:n Record number Page number
I'`'. . �0r-073-/z-Aero a"�6a.V 096/6 38,57
• �� value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
dabs,anent year assessment date,current year dale of application legal or equitable owner?
Or 095V 000 ❑ Yes ❑ No
If no,what is his I her exact sham of interest? I If owned with someone other than spouse,indicate with whom
If name on record is different than that of appricant,'u diple below. is OrE property in question:Annually Assessed
Real Property ❑ Annually Acsecsed
• Mobile Home(IC 6-1-1-7)
Name of mortgagee or contract seller Lt'e
Address of mortgagee or contact seller(num and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage ■
Address of assignee(number and sheet cIh:state,and ZIP code)
4
Does applicant own property in any If yes,what county? at Taxing District? Has this deduction been requested If yes,state amount of deduction
other ❑Yes ❑No curre�y ar? ❑Yes 0 N
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 line of credit that is recorded in the county recorders office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction apnrmenii in o,- -. — -- - --
zo_ Rin�I �V V. a �0_V�o•. J •
20 20 20 20
�o.1\c.w. A., b k 2 c,
Signature of 3, County Date(month,day,year)
il1 \000. UU (- 45- 1C2
I/We ce .-a(D t(Q_3831 ig information is true and correct and that the applicant is a resident of Indiana and
• ner/c ation is tiled.
Sig re •. e) - - 'Date(month,day,year)
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Full resident ad..... pplicant(number and sb'eet city.state,and ZIP code)
X 163q •.Vca,reriko-,17-6 H-&.a_bd`a.d+ ►N) t4-1IP3g
Person authorized by duty executed Power of Attorney or by 1C 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet 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. .