HomeMy WebLinkAboutMortgage_Spear STATEMENT OF MORTGAGE OR CONTRACT INDEBT €$$� nt9 Township Year
FOR DEDUCTION FROM ASSESSED VALUATION 9 p
State Form 43709(R13/10-15) .. _ 11..
Prescribed by Department of Local Government Finance
INSTRUCTIONS: DEC '7 2016 File Mark
To be filed in person or by mall. Form Ned wfth:
Firing Dates: t) Real Property.:Must be completed and dated in the calendar year for which the ded is.so M.
Must be filed or postmarked with the County Auditor or County Recorder of the cour� rfy is 20- my Auditor
located on or before January 5 of the immediately succeeding calendar year
nIR O NT`r AUDITOR ❑
2) Mobile/Manufactured Homes not assessed as Real Property:Must tile withmE or of the county County Recorder
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought .
See reverse side for additional instructions and qualifications.
Applicant(owner orcontract buyer-see restratioccon w side) ^ r •
brh 1, rn C` `T 1� (--, , y\ • )rbot..Thi
- :: • Key number I legal description I Record number Page number
n,., r r( l,2— 3' - 35 - 10y -`aril st'71-7 r ao/6 ws--3Cc
„value dread property as of Mortgage/Contract indebtedness unpaid as of . Mortgage/Contract- unpaid as of Is the applicant the sole
- date,asrerrt year assessmerd data,amen year date of application legal or equitable owner?
/t1 900.0 0 yes ❑ No
•
If no,what is his 1 her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below. Is the property in question:Annuuaalllly Assessed
rnprt�9aJg� Property ❑ Home1.1-7)
Nana cd X--1 cA
Address of mortgagee or contract seller(number and street,city,state.and ZIP code) _
Name of assignee or other owner or holder of mortgage '
Dra'YC1' 1 'o
Address of assignee(munber ard street,ay,state,and ZIP code) •. •//�.. ..
Does a p p l i c a n t a t m property in any 0 yes,what county? . What Taxing District' Card N O. ,/5[... wt of deduction
other in Indiana? ❑Yes 0 N ' / tuts j] `....
A person is not entitled to this deduction unless the person has a balance on th j )—J t ^ ended in the county ' —
recorder's office(mdurfng any home equity fine of credit that is recorded in the county lc,.,,.__. - 111 I - ,n.
COUNTY AUDITOR ' "'lll _
Deduction approved in the amount of:
•
20 20 20 20 20 20 20
Signature of County Amide, County Date(month,day,year) '
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/contract buyer of the aforementioned property on date application is filed.
5' (owners MI Data(month,day,year)
X h,-�M.tnk, AA
Full resident address of (number and sheet,city,state,and ZIP code)
x 99/79 k rimy Lord l�nuIr iJF, hN L/76939
Person authorized by duty a�,ted Power of Attorney or by IC 6-1.1-12-0-7 Date(month,day,year)
Address of authorized person (number and street.oily,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.
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