HomeMy WebLinkAboutMortgage_Anderson (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15) • ggu•
Prescribed by Department of Local Government Finance 1 11- 1 Ft, D
04STRUCTIONS:
File Mark
To be filer/in person or by mail DEr 's-,:a n,:
firing Dates: 1) Real Properly:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the where the property is ❑ Coun Auditor ,
Y P Part)
located on or before January 5 of the immediately succeeding calendar year. if 7!. .'•2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County Auditor of the �'/'r`-')Ji.1 Recorder
where the property is located during the twelve(12)months before March 31 of each year the did •
See reverse side for additional instructions and qualifications.
/
Applxa or.. -buyer-see reverse side) '
.. • .,gem"( Key ,testy/- /legal desaiption Ramrd g Paggeytr ro? -/ _ „, aw-UO'{.SlS-.dot-/ d6/<0 - '.�` 97,Mortgage/Contact Indebtedness unpaid as of • Mort gage/Contract indebtedness unpaid as of Is the applicant the sole
year assessnerd date,amend year date of application legal or equitable owner?
/�'d,'oU() ❑ Yes ❑ No
If um,what is his/her exact share of interest? If owned with someone other than cprurcr,indicate with whom •
If name on record is different than that of applicant,inchoate below: is property in question:Annually Assessed
Real Property ❑ Amway Assessed
Mobie Home(IC 6-1.1-7)
Name of mortgagee or caramel seller /
S .
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage 'ate, /7 ci,Address of assignee(nw•nber arm/street ay, te,and ZIP code) /I
Does applicant own properly in any If yes,what county? • what Taxing District? Has this deduction been requested Ryes,state amount of deduction
other county Indiana? ❑Yes ❑No • cement�? ❑Yes ❑No
"'-- ��person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
--r'that is recorded m the county recorder's office)that is the basis for the deduction.
I Drawer O COUNTY AUDITOR •
Ca I'd NO. ...... �9 20 20 20 20
•
County Date(month,day,year) .
I I We certify under the penalty of perjury man um...rove and foregoing information is true and correct and that the applicant is a resident of Indiana and
fib) owner/contract buyer of the aforementioned property on date application is fled.
W ....•��-, �{ n Data(month,day.year)
F e rte.-,
' ( 1” LI-1 �(.5
aut or�d by duly executof Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet,ay,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.