HomeMy WebLinkAboutMortgage_Pinnick (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
County Township Year
r FOR DEDUCTION FROM ASSESSED VALUATION
state Fonn 43709 p /10.15)
Prescribed by Department
of Local Government Finance +tl¢.J�
rk
INSTRUCTIONS:
t
To be filed in person or by mail Form filed with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is ruin C9 2016
Must be fried or postmarked with the County Auditor or County Recorder of the county where the properly is ❑ County Auditor
located on or be fare January 5 of the immediately succeeding calendar year. to
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County •. 'le:,: . r/ County Recorder
whew the property is located during the twelve 12)months befow'T'Wrh 31 of each yeg ..;A^:�I� —
See reverse side for additional instructions and qualificatio `a1_ � '� 'UDITOR -
AppUCad( or contact buyer- reset ' on re s/r .
Taxing District Key number/legal description Rend Page
at— 13- 13-30n -DOI- 115') - OOb • (P ` 9
Assessed value Meal popery as of Mortgage/Contract indebtedness unpaid as of - Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessnvard date,and year mma.ar data,and year date of application legal or equable owner?
L c, \ 5 D0 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applcant,indicate below: Is the property In question:Annually Assessed
• ❑ Real Property ❑ Armuatly Assessed
Mobile Home(IC 6-1.1-7)
Named mortgagee or rxmtract seller 513
Address of mortgagee or contract seller(number and street dry,state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage .
Address of assignee(number and street rdy,state,and ZIP code)
Does applicant own property in any If yes,what county? I What Taring ? I Has ties deduction been requested If yes,state amount d deduction
other county ` --- ---"-x
in Indiana? ❑Yes 0 N - \ tl` • DYes ❑No
A person is not enbted to this deduction tin) (�1 Lj. � . K. P,vvv.\c-`� v contract indebtedness that is recorded in the county
recorders office(including any home equity A. U ,e)that is the basis for the deduction.•'4- 'C?n.\3 o vLVCVc.
Deduction approved in the amount of: / wh .
20 20 e \a\ 5 00, O ct 20 20
a� lL ` SU�� \� -a \V •
Signature of CountyArnLter I - 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
.• er/contract buyer of the aforementioned property on date application is filed.
_It e Data(month,day.year)
till resident address of applad�r �city,state. ZiP e)
( 0603 e /00S Q - �Z.GO
Person authorized by duly executed Power af Atomey or by IC 6-1. - -0.7 Date(month,day,year)
Address of authorized person (number and street,o7y,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.