HomeMy WebLinkAboutMortgage_Hoover (3) 0a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township ' Year
. •` FOR DEDUCTION FROM ASSESSED VALUATION p
-(7--' �'- State Form 43709(R13110-15) J
�— Prescribed by Department of Local Government Finance Fit _
INSTRUCTIONS: File Mark
To be filed in person or by mail. NOV 1 ' 2016 Form filed with:
Filing Dates: 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought
Must be bled or postmadced with the County Auditor or County Recorder of the county where prope is County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Coy Rrt Arid' e
where the property is located during the twelve(12)months before Mardi 31 of each j A' ti4 4 u4$d D I—OR
See reverse side for additional instructions and qualifications.
Applicant( or contract buyer-see restrl�i i�-o^/��1�onnreevers�e',siiddee)))/.
Taxing D' an') Key number/leg a rdescripfgn Record number Page number
26-a a -0 I ao / 000 /79 ea 9 ao i47 3 99 y
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date,curtest year assacwynorworate,current year date of application legal or equitable owner?
a 5 (50 a ❑ Yes ❑ No
If no,what is his t her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate belay. [Is the property m aural :Annual/if Assessed
innually Assessed
9obile Home(IC 6-1.1-7)
Name of mortgagee or cont sue _ - _ ��� `C C31 Q{-4
Address of mortgagee or contact seller(number and street city,state,and ZIP code) c CviNSN �00�
Name of assignee or other owner or Muter of mortgage n r CU-
a ,�� t �>
Address of assignee(number and street,city,state,and ZIP code) a p 11u -
Does applicant own property in any If yes,vital county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county ,--, property for
in Indiana? yes ❑No parent year? ❑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(including 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 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
•
I 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.
Sig lurre(owners
,�full name) t•F Date(month,day,year)
S
Full resident adp of applicant(number and street,city state,and ZIP code)
X 5444 it)..ixmL I (e0 6tw#2
Person authorized by day executed 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. •