HomeMy WebLinkAboutMortgage_Brown (6) ,� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
r FOR DEDUCTION FROM ASSESSED VALUATION
;.: Sat Form 43709(R13l tats) -
Prescribed by Department of Local Government Finance . Se
aib
INSTRUCTIONS: : �' ..
lb be filed in person or by marl - Form with:
Fling Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. V i 11s
Must be filed or postmarked with the County Auditor or County Recorder of the county wham the property is. coy&uditor
located on or before January 5 of the immediately succeeding calendar year.
' p County 2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County Auditor of the county Recorder
where the property is located during the twelve(12)months before March 31 of each year the deductiavGlit a r•.. : 1'--v 17,T.
See reverse side for additional instructions and qualifications. COU ' •
Applicant , " orcontrad buyer-see resuictbns n3 side) NTM 1tJDl tOR
T" d : r..d
Key nurMer t legal number Page number
,/ j,-;ca of6_. ydr
' z co- oo.R• S7i Qa4 o a/ J99/
• !value areal properly as of r Contract indebtedness unpaid as of • Mortgage/Contract indebtedness unpaid as of Is the appfxant the sole
--•�`. lets,aslant r assessment date,anent year date of p /h legal or equable owner?
legal
❑ Yes ❑ No
If ro,what is Ids!her exact share of interest? If owned with someone other than qvv re.P,indicate with whom
If name on record is different than that of applicant indicate below: Is ropeny in question:AnnuafyAssessed
/ eat Property ❑ Annuaey Assessed
Home(tC 61.1-7)
Nano of mortgagee or contract seller ]/A/A1-7"
Address of viwtgauee a contract seller(number and street city,store,and ZIP code) 1
Name of assignee or other owner or holder of mortgage ' J
•
Address of assignee(number and sheet thy,state.and LP code) \//�/ � ,J y/7/�/ 3.404•0 `
Does applicant own property in any t yes,what county? what Taxing District?%�'te!Has this (es' A .of//3 //r
other Inl Indiana? ❑Yes ❑No arra property
nrtyean ❑Yes 0 N �J
.4 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 '
tecorrler's office(Indudmg any home equity fine oferedd that is recorded in the county reconfer's office)that is the basis for the deduction.
COUNTY AUDITOR "
Dedudion approved in the amount of
20 20 20 20 20 20 20
Signature of CardyAuddor Canty Date(month,day,year) .
I 1 We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner!contrail buyer of the aforementioned pro on date application is filed.
•
1 p.:- . funname) A/ ' Data(month,day,year)
\'. / i resident t( d/,tJds ' -ft /I-(.r.r.L /l. Gt/,v,"
i resident address ap('plicant sheet state,and e)
/( �7 r-. a if 4_4 fhnL. —
Person authorized by duly executed wer of Atomey or by4C 5-i.i-12417 Date(month,day,year)
Address of authorized person (number and street°Ty,slate,and ZIP code)
The penalties for perjury can include imprisonment up to two end a half years and a fine not to exceed$10,000.