HomeMy WebLinkAboutMortgage_Abbitt - STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
'�'• State Form 43709(R13 1 10-15)
S�'mil Presamed by Department of Local Government Finance
• File Mark
lb be filed in person or by mail. OCT 2 ` fe46dwdh:
Wing 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-- ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. tl.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor• •- ".'' y!"�; •unry Recorder
where the property is located during the twelve(12)months before Match 31 of each year the•,_•tr•-)%1'V t WS— • v e •
See reverse sid: •• additional instructions and a ifications.
'istnc J is-i - .5G 5466/ 6a9- oa? rOi ` eu9e9
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of 1s the appli ant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
a 3s d v'r C7 ❑ Yes El No
If no,what is his I her exact share of interest? If owned with someone otter than spouse,indicate with whom
If name on record is different than that of appal an • irate below, is th property in question:Annually Assessed
eal Property ❑ Annually Assessed
•
a Mobile Home(IC&7.7-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street city,state,and ZIP code) �6
Name of assignee or other owner or holder of mortgage i 7);(21,Address of assgnee(number and street city,state,ant ZIP code) ����-i' /1
Does couny applicant own property in any I If yes,what county? I What Taxing District? on Has prfopervy for /been req IL92s, m
in other Indiana?county n..__ on current year?for (((,.YYY��� (XJ CCCJJJ •
in Indiana? ❑Yes - —. _ mrent year? ❑Yes No
A person is not entitled to (' l Te i-k E LE m R ( rTf an's mortgage or contract indebtedness th t is recd ed in the county
recorder's office indudin; /recorder's office)that is the basis for the deduction.
TOR ,
Deduction approved in the a
20 1 20 20 20
Signature of County Auditor fly Date(month,day,year)
1
I/We certify under the penalty of perjury that the above and foregoing information is true and cored and that the applicant is a resident of Indiana and
owner/contract buyer of the arui ementioned property on data application is filed.
I Sgnapre(ownets tel name) Alt– Date(moods,day,yea')
Full resideeit address of awfica.nt(number and street illy,state,and ZIP code)
tBD2 o )evMktd 1 . p avL) (.�-7 lei a
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 penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.
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