HomeMy WebLinkAboutMortgage_Douglas (11) -6j. STATEMENT OF MORTGAGE OR CONTRACT IND S ,,1_ ^. i1 Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(8131 10-15) '
Presented by Department of Local Government Finance
INSTRUCTIONS: NOV 10 2016 File Mark
lb be filed in person or by marl. Form fled with:
Firing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the uctjon' so t.
Most be filed or postmarked with the CountyAuddor or County Recorder ofthe.ad roperty is '" t minty Auditor
located on or before January 5 of the immediately succeeding calendar N �TV ����(�ITOR
2) Mobile/Manufactured Homes not assessed as Real Properly.Must fr76i1ibe�lyAtitldorr ai�e county County Recorder
whew the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner ocontraabuyer-see . . on re side)�.y,
/6ll�,l/LW H 4ns�C ber I lgal•/r!
Taxing D/� Key number/legal Renard number Page number
11 ,l ia-o 5 k co 7 - oo a 3/7 o/,? /6 'S/08''il
Assessed value areal property as of gage/Contract indebtedness unpaid as of . Mortgage t Contrail indebtedness unpaid as of Is the appticam the sole
assessment date,cement year assessment date,=rent year date of application - legal or equitable owner?
35.27 3 ❑ Yes CI No
If no,what is his 1 her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is afferent than that of applicant,indicate below: 'Assessed
Assessed
Named mortgagee or contract seller Xne(IC fr1.1-7J
� I�oucr�s, DR .
Address of/antgagee or=had softer(number and street,ray,state,and ZIP code) ��� �''„^
Name of assignee or other owner or holder of mortgage ' �� /
Address of assignee(number and street sty,state,and ZIP code) Aria) •
�apli t own property in any If yes,what cou ty? - What Taxing Dssbtd? �� N � / � i deduction
in Indiana? ❑Yes 0 N • ,.{.. _1 balance on the
recorder's office i�uding any home equity fine of ameht that isarecorded ,the c !91r J/ U �� J' ii the county .
COUNTY) 'tf •
Deduction approved in the amount of �'y/
20 20 20— 20— ' _ 408 / •
Signature of County Auditor
-
I I We certify under the penalty of perjury that the above and foregoing inform Indiana and
cone`contract buyer of th--y.rementioned property on date application is f
S i la //
w/
F i d (nu �sfree; te,and BP oaQe)
authorized by duty exeaended Power of � ��
Attorney or by IC 61.1-12-0-7
Address of authorized person (number and street,say,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.