HomeMy WebLinkAboutMortgage_Myers (5) } STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.,f'_ FOR DEDUCTION FROM ASSESSED VALUATION
`7=.•'�'..:' State Form 43709(R13/10-15) fir.,
Presorted by Department of Local Government Finance .u�"(,'
INSTRUC77ONS: In,,Th
File
lb be filed in person or by mail. NCo filed with:
filing Dates- 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought oT Z n
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is Coul Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ u Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the unty
stem the property is located during the twelve(12)months before March 31 of each year the dedudfo
See reverse sic additional instructions and qualifications. SUN 7Y
•1 1..
Ap -tent( er or tract buyer- ,Eigia: ee
n { /60A0- 1—/X--0--). .56
d/X� //legal 07 03 - 00/ 99 Od32 number 'I67 4
Assessed value of real property as of Mortgage 1 Contract indebtedness unpaid as of Mortgage/Contract tndebtedngggsss unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date a cap 2 at legal or equitable owner?//C/�� /!L ❑ Yes ❑ No•
If no,what is his/her exact there of interest? If owned with someone other than spouse,inmate with whom
If name on record is different than that of applicant,indicate belay. GIs th properly in question:Annually Assessed
'Real Property ❑ Annually Assessed
�\ Mobile Home(IC 6-11-7)
Name of mortgagee or contact seller 62-ne/e U Address of mortgagee or contract seller an sate ) a O\ - 1(.i�y -
Vi.)v,4\ A .4_ .. tr•v.e C3. (`1iec5
Name of assignee or other owner or holder of mortgage y n G J�
Address of assignee(number and sheet,city,state,and LP code) `u b \V).-`\L
Does county applicant own property in any If yes,what county? What Taxing District? Has�ddeeduucr
in Indiana? ❑Yes ❑No current year? ❑Yes ❑No
A person is not entted 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 approved in the amount of
20 20 20 20 20 •20 20
Signature of County Auditor County Date(month,day,year)
•
I/We certify under the penally 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(prner�(gname) /
Date(mantlm,day,yea)
J. Full residerd�addressra applicant number and sheet,city, ,and ZIP code)
g/5.
/5 6- Leditt ,.t,± sA e n/cator., IA/ Y >G 70
Person authorized by duty executed Power of Attorney or by IC 61.1-12-1.7 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. _ -