HomeMy WebLinkAboutMortgage_Terry (2) r STATEMENT OF MORTGAGE OR CONTRACT INDEBTED' I JEJC1th][) Township Year
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re, DEDUCTION FROM ASSESSED VALUATION
i Stara f-om 43709(R73/10.15)
Prescribed by Department of Local Government Finance NO V 10 2016
INSTRUCTIONS: Rte Mark
To be filed in person or by mail. n 'Form filed with:
flung Dates: 1) Real Property:Must be completed and dated in the calendar year for which the d o
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Must be filed or postmarked with the CountyAuddor or County Recorder of the is County Auditor
located on or before January 5 of the immediately succeeding calendar year. CC�i�l tt33 SS OO CO U T A D ITO R
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County Auditor of the county ❑ County Recorder
where 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.
` (owner cot/ e d- Pak4 \f S Tarry
flnee ion Key "° - W- lS aoa-oo1 . (1-b�-oa8 i(, 33Z1
Assessed value of real property as of Mortgage I Contact indebtedness unpaid as of . Mortgage I Contact incletdedness unpaid as of Is the applicant the sole
assessment dole,arrant year assearent date,anent year date of app pion legal or equitable owner?
?ZR OYes 0 N
If no,what is his!her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is ddferait than that of applicant,indicate below. Is the property in question:Ann way Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 61.1-7)
Marto at mortgagee or contract seller
T-12-nn y M etC (C-laC)
Address of mortgagee or antrad setter(number and street city,sta and ZIP code)
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Name of assignee or other owner or holder of mortgage ' -
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Address of assignee(number and street ay,state,and ZIP code) .
Does applicant own property in any I If yes,what county? • What Taxing District? Has 'deduct u been requested If yes,state amount d deduction
in J rent year? Yes ❑No
AI U a. ?c S v S has a balance on the person's mortgage or contract indebtedness that is recorded in the county .
rot es t�� \ \ at is recorded in the county recorder's office)that is the basis for the deduction.
r\ QC\I- 1 -\ I--Q C �F i o`no+ COUNTY AUDITOR • • -
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a n_ q;mss .o° �°( � zD 20 20 20
Signature of County Auditor County Date(mania day,yew) '
I 1 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! d buyer of the aforementioned property on date application is fled.
full name) Date(month,day:year)
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tm resident a at applicant(numbs street city,state.and )
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a dby duty of Attorney or by IC 6-1.1
y Date(month,day,year)
Address of authorized person (number and street sly,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.