HomeMy WebLinkAboutMortgage_Duncan (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBN Toon Township Year
';'- FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R13/10-15) -
Prescribed by Department of Local Government Finance
INSTRUCTIONS: NOV 16 2016 File Mark
To be filed in per on or by maul. Form feed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the del • nls v
Must be filed or postmarked with the County Auditor or County Recorder of the erty is- jj County Auditor ,
located on or before January 5 of the immediately succeeding calendar yearq N COUNTY AUDITOR
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with use Auditor of the county County Recorder
where the property is located during the twelve(12)months before March 31 of each year the dedudibn is sought
See reverse side for additional instructions and qualifications.
Appf � merno r itr -tee restrictions onverse de)
hat/ � /
Taring District number/legal
desctption Rend number Page number
/Yuan "- 076-17-0Z/ /DO 60 hi 3y oo21 a o/(o 5'350
Assessed value real propesty as of Mortgage/Contract indebtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment dale,aarard year assessmeJrd date,amend year dale of application legal or equdable owner?
17"218.010 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spew,.indcte with whom
If name on record's different than that of applicant,indicate below. Is the property in question:Annually Assessed
❑ Real Properly ❑ Amuaty Assessed
Mobde Rome(IC 6-1.1-7)
Name of mortgagee or
////II
Address of nrur4pye..or contract seder( and sheet,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage '
Address of assignee(number and street ay,stole,and LP code) -
Drawer NO.... .... .. • .
Does appll nt own property in any If yes,what county? - What Taxing District? it of deduction county other ❑No
in Indiana? ❑Yes
A person is not entitled to this deduction unless the person has a balance on the p Ca 1- 1i �3 in the county '
recorder's office(including any home equity fine of credit that is recorded in the to
COUNTY Al
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day year)
I 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 I contract buyer of the aforementioned property on data application is filed.
Sranahae erb fryM1n�p;e) -... - -- Date(romh.day.year)
la
Full resident addresses aappliicant(number and street city,state,and ZIP )
-r=/aril' 6%sf 750 3 Owetre;/ .240 777as
•
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day.year)
Address of authorized parson (number and street alp,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.