Loading...
HomeMy WebLinkAboutMortgage_Esarey (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION . '= State Forrn 43700(R13!10-15) <4;C:":- Prescribed by Department of Local Government Finance Fibec. =r INSTRUCTIONS: k To be filed in person or by mad. with: Filing 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 proper4V 1 I R r 0 3CUnty Auditor . located on or before January 5 of the immediately succeeding calendar year. 2) Mobile/Manufachaed Homes not assessed as Real Property.Must file writ,the County Auditor of the county County Recorder where the property is bated during the twelve(12)months before March 31 of each year the deduction is' •■z. MIN Pr.'"-- See reverse side for additional f - and q cations. E :I( • Olt /ttructions ) GIBaON cull I Y AUDITOR T " shi- // Key nypber/legal saiptin / / Remrdmmbm - r at drawl property as d Mortgage t Contract indebtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of Is the applicant the sole dab.ascent year assessme t date,anent year dab of appli ation //,, legal or equitable owner? application �V ❑ Yes ❑ No If no,what is his!her exact share of interest? If owned with someone other than Vv"le.^,indicate with whom If name on record is Moroni than that of applant,indicate below: Is property in question:Annually Assessed eat Ruperty ❑ AmnlaOyAssessed Moble Home(1C 6-1A-7) Nana of mortgagee or contract seller Address of mortgagee or contract seller(number and street, ' state,and e) //1/ Name d assignee o other owner or hotly d Mortgage r / / 2 3 / J—/O /� Address of assignee(number and street ay,,state,and ZIP code) �f9f/�/ C—atV /Lf� // Does applicant own property in any I If yes,what county? What Taxing District? Has this deduction been requested if yes,state amount of deduction other in ` '"[[�—r_l v..._❑Nn_ _ - anent�? ❑yes El No A per LJ A '\E Y B2v n, 'sarecord�the minty recorder's officeJ�tras the basis for that uctiwon. in the county . recce tt nnTE n m COUNTY AUDITOR • Dad Tf f rvy / - /Lf 541 20_ 20 20 20 Signaune N _/(D County Date(month,day,year) - — 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. � �name) 6 Date(month,day,year) \ r- Full resident address of applant(number city,y,state,and ZIP code) SYC 2 T /025 -S N406,sfn©t .---1(/ /17(-3" 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 sheet aay,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.