HomeMy WebLinkAboutMortgage_Robb (2) �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Countp I�vrrlsFlip-i near
fi -- FOR DEDUCTION FROM ASSESSED VALUATION NL �-1/
r'.-)% State Form 43709(R13/10-15)
�f- Presaled by Department of Local Government Finance
INSTRUCTIONS: N@10 purl 2016
To be filed in person or by mail. Form filed with:
Rung Dates 1) Real Property.Must be completed and dated in the calendar year for Windt the deduction is sought
Must be Wed or postmarked with the County Auditor or County Recorder of the county where the property is • Auditor
boated on or before January 5 of the immediately succeeding calendar year. GG�y�N C 0 T�}Y19Cfl ®4
4r
2) Mobile I Manufactured Homes not assessed as Real Property:Must We with the County Auditor of limy
where the properly is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse std n addi' nal insl ��sans.
Applicant 'f see on ((77/J
T D Key /legal Record number Page �r iox.ex
Asse4j..-464.4 00r0 j� /609-66d. .s- 6a 2 , 0 /a 6
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract' ebtedness unpaid as of Is the nt the sole
assessment date,cunent year assessment date,anent year date of appfip / legal or equitable owner?
❑ Yes ❑ No
If no,what is his l her exact share of interest? If owned with someone other than sprw¢a,indicate with whom
tf name on record is different than that of applicant indicate below: Is property in question:Annually Assessed
Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller � �
(.Li 0.-4--✓
Address of mortgagee or contract seller(num'a a•d. --t city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street nTy,state,and ZIP code)
• AL Ali / 7_02_ ,0 /A-e
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other Indiana?county ❑yes ❑No wrrerePl yeerto` ❑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 fine of credit Mat is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved--------1.,_`_
20 V — _— _ 20 20 20
Signature of Count) P. - / d_,. County Date(month,day,year)
I I We certify u /1_ - 4/ 9(_ (0 iformation is true and correct and that the applicant is a resident of Indiana and
I owner/contra l!/ m is filed.
r Signature(owners / 4/764) Data(month,day,rear)
/VN ,', tele/1 V , //uf.nv ir,al,/)a <V ICe/o4//1 1/- 9 a%(
f Full resident address of app t( umber and street city a.and ZIP code)
/ 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 axle)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. - .