HomeMy WebLinkAboutMortgage_Harrington .a. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year .
".; .'t FOR DEDUCTION FROM ASSESSED VALUATION
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Stste Form 43709(R13/10-15)
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Presaibed by Department of Local Government Finance N
File
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INSTRUCTIONS:
To be filed in person or by mail. OCT°
Filieg Oates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought 7 sedifj
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is 0 Cou Auditor
boated 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 th nty 0 u Rewrder .
Mere the property is located during the hvelve(12)months before March 31 of each year the deducti
See reverse side for additional instructions and qualifications. COUNTy AUD„.. _
ITOR
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7 /- numper neg,C1.04,-.. Record number Page number
Assesperb-n 4e 4_, C 0g6./ r 9-/at., coo. lift_076 on) it° 44 5 go.
value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage!Contract ind edness unpaid as of Is the applicant the sole
assessraant date,current year assessment date,=rent year date of applicabong, 6_60 legal or equitable owner?
0 Yes 0 No
If no,what is his!her exact share of interest? If owned with someone other than(pouse,indicate with whom
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If name on record is different than that of applicant,indicate belovc Is the properly in question;Annually Assessed
0 Real Property 0 AnnuallyAssessed
• Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller
ErciLe 21 ...._ .
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Address of mortgagee or contact seller(number and street,city,state,and ZIP code) -..
Name of assignee or other owner or holder of mortgage e __,.:2
Address of assignee(number and sheet city,state,and ZIP code) IE '
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Does applicant own property in any If yes,what county? What Taxing District? -t- C,_ ' I ko X aduction
other county ,--,
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in Indiana? LJ yes El Na
A person is not entitled to this deduction unless the person has a balance on the person S... LI • c. A' n the county
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recorder's office(including any home equity line of credit that is recorded in the county recorders t....
COUNTY AUDITOR
Deduction approved in the amount of:
20 _ 20 20 20 20 20 20
Signature of County Auditor County , Date(month,day,year)
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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 filed.
Signature( alinamen9p,? Date(month,day,year)
IL — A /617,157:74#41'.
t\ Full /xi.? ofiaaft mber an slie:5.1,city, d ZI(7e) ca 4
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 penalties for penury can include imprisonment up to two and a half years and a fine not to exceed$10,000.
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