HomeMy WebLinkAboutMortgage_Ruggles � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� county Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
- State
reScrribe 43709 par m nt of FILE t,-
Presrxibed by Department of Loral Government Finance
INSTRUCTIONS: de Mark
To be filed in person or by mall. ^^''(�u9 2016 Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction it's M:
Must be filed or posbnariced with the County Auditor or County Recorder of the county whew the property is County Auditor
located on or before January 5 of the irnmedia(ely succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County - County Recorder
where the property is located during the twelve(12)months before March 31 of ea ty •,.,. ti !i ^L']•�. —
See reverse side for al instructions and qualifications.
j""�`� �ITOR •
Applicant(owner or jwyfor-see restrictions re side) 1
/,,ox r e .•")g Pao •
.-..'ct Key number deses�tion Record number 'Page number
40.4.1 I b - ._3 1-- • -ooa. /7 v ,_. 'fSSo
• __._.value drat l property as of Mortgage/Contract Indebtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of Is the appecard the sale
assessment date,current year t TJ 6o 0 legal or etgdable owner)
❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned With someone other than sperms,indicate with whom
If name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
❑ Real Property ❑ Aimuaty Asst�d
\' �( Mobie Home(IC 6-1A-7)
Nam Na of mortgagee or contact seller
Address of mortgagee or contract self(number and street,city,state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage '
•
Address of assignee(number and street oily,slate,and ZIP code)
•
Does applicant own property in any I If yes,what county? -_ I What Taxing District? Has t>s deduction been requested byes,stab amount of deduction
oder in dam? DYes ❑I A�e.r fu95/es- =rent year? DYes El No
A person is not entitled to tit; {+5 mortgage or contract indebtedness that is recorded in the county '
recorder's office fmdudag at d-0 /L - t f-S So 'order's office)that is the basis for the deduction.
Drawer NO t - .
Deduction approved in the amou
Ii lee - /o - dG - /L • •
20 Card 1 O. 20_ 20 •20 .
l
Signatur d Auditor County Date( day,
I 1 e 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.
\Signature(own �c .r," / Date(month,day,}rear)
but resident address orb.e —. (number and street,city,state,and ZIP code)
SO 1//YS F /zoo S /f/o/394 9 -PiV 7 76 3 9
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.