HomeMy WebLinkAboutMortgage_Johnson Commercial Mowing Inc -r, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'
FOR DEDUCTION FROM ASSESSED VALUATION
D. " State Form 43709(R13f 10-15) -. . -
`„
S l Prescribed by Department of Local Government Finance
�
INSTRUCTIONS: Fit ; i )
Tb be filed in person or by marl • i>.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 CountyAuddor or County Recorder of the county thhem the pijJy 4 3 20 60 County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufacbned Homes not assessed as Real Property-.Must file With the County Auditor of the county
where the property is beefed during the twelve(12)months before Mang 31 of each year the ded is -. .% -
See reverse side for additional instructions and qualifications. Wl rnl►1
Applicat orcontract restrictions UIBS0N COUNTY AUDITOR'
II,T. 4 fi ,'. IKey number f legal desertion /Y� .� 470 Record um.�y Page
i�'�k p a6 -ex-3a —y00- 0 0 -01.7 010/(%. 03
r ss>Redvalue of real properly as of // Mortgage I Contract indebtedness unpaid as of - Mortgage I Contract indebtedness unpaid as of Is the appfmant the sole
assessment data,anent year assessment date,nmert year �of D legal or equitable owner?
rJ50 0 ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other tan spouse,intimate with whom
If name on record is different than that of appfvant,indicate below. Is the property in question:Annually Assessed
❑ Real Property ❑ AnnuaIly Assessed
Mobile Hare(IC 61.1-7)
Name of mortgagee or contract
Address of mortgagee or contract seller(number and sheet city,state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage '
Address of assignee(number and sheet of state,and ZIP code) -
Does applicant own property in any If yes,what county? - What Taxing District? Has this deduction been requested If yes,sate amount of deduction
other county �?
in Indiana? ❑Yes El No - 'current ❑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 that is recorded in the county recorder's office)Bret is the basis for the deduction.
COUNTY AUDITOR ' -
Deduction approved in the amount of:
20 20 20 20 1 20 I —'an — 20
Signature of CountyNWtor - a;day year)
I I We certify under the penalty of perjury that the above and foregoinc algal `-r a resident of Indiana and
owner/contract buyer of the aforementioned property on date applica D I a��' I' N O
Sngnatme(a
name) �� 411.e r4 daY•Yew)
% 7i�1�l'/mil/ Card NO.
Full resident address of applicant(number and street city,state, ZIP code)
'-137o id Joe A.cwc,e- -
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 Ouster 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.