HomeMy WebLinkAboutMortgage_Clark (8) .ems r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' FOR DEDUCTION FROM ASSESSED VALUATION
:l ':2 State Form 43709(R13/10-15) FIT S. I Prescribed by Department of Local Government Finance IF I I nBa 3)
INSTRUCTIONS:
To be filed in person or by mail. Form filed with:
Filing Dates' 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought T fC,
Must be filed orposbnarked with the County Auditor or County Recorder of the county where the prope (s 2 6 LYJ 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 the unty County Recorder
where the property is located dung the twelve(12)months before Mardi 31 of earl;year the deductio
See reverse side for additional in., i.•. and qualiifications. //�1 G 7COUNTYAUn)TOR
Appfcant oont �p�er on reverse side) /�/j/ ‘��. ,, )a4 C9C .F
7 D. v 'fore _� jt 7 3 _ Q Record number Page number
o Q00. p 1 }0 Li(0
slue as of Mortgage I Contract indebtedness unpaid as of l Mortgage/Contract ness unpaid a ass of Is the appliam the sole
assessment da year assessment date,current year date of appfiration /e legal or equitable ormeN
❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,intricate with whom
If name on record is different than that of applicant,indicate belovw Wopa in question:Annually Assessed l Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller O Address of mortgagee or contract seller(nu�street,cd3:state,andPccode)21.
Name of assignee or other owner or holder of mortgage f/�/1 Address of assignee(number and street,city,state,and 2IP code) 6 L�z 7 id/A 2 Does Does ap t own property in any If yes,what county? What Taxing D Has p o��(i•H requested If yes,state amount of deduction
in Indiana? ❑Yes ❑No current year? I.Yes ❑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(induding any home equity line of credit 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_ —C- S. C�a,�
�J ``.5 0 V� 7. Ck e—m-� �p . 20 20 20
Signature of County Audit Q\r,,r 1 5 t \' unty Date(month,day,year)
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I/We certify under tt ( T _ 1 u1 is true and correct and that the applicant is a resident of Indiana and
owner/contract buye b �.- J .
y'�\ pOa. b
S (owner. , I nam. v Date( ,day.year)
a�!% r . -../ /0 02 eAi
Fug resid:. t address of appfcant(number and st eet o1Y,state,and ZIP code) •
C/i/ (Yhoc 7L Si Oak/a•-td C/fy -r,i x/7/60
X Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 r 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. .