HomeMy WebLinkAboutMortgage_Kelly STATEMENT OF MORTGAGE OR CONTRACT INDEBIEPNE Township Year FOR DEDUCTION FROM ASSESSED VALUATION l-( YR
• State Form 43709(R13/10-15) .. •
Prescribed by Department of Local Government Finance
INSTRUCTIONS: DEC 1 3 2016 File Mark
To be filed in person or by mal. Form fined with:
Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the d op is ug
Must be filed or postmarked with the CountyAtrdlor or County Recordersy eoofthe ccoId/ ��((��I�,�rtrt�l�7�7vv LLmppnerry iis� ❑ County Auditor
located on or before 2) Motile/Manufactured Homes notasssessed immediately
asas RReal Pry calendar t fife drd/f'tifatbtm9Atrdltdr&the Loamy ❑ County Recorder
where the properly 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 or buyer-see restrtd>ons on reverse yde) " " •
Taxing D' Key mintere /legal desa�tion Record number Page number
Cnfar �` at - I61 - I (A' - r30i - coo '981 - oa G- 2-0 oflp .s .2. Acf
Assessed value of mat property as of Mortgage 1 Contract indebtedness unpaid as of - Mortgage I Contact indebtedness unpaid as of I Is the apps ant the sole
assessment date,current year assessrrent date,anent year date of application __ rwmr---able owner?
Use,what is hs/he exact share of interest?
A2 7521 It owned Sri d'I- 35 ❑ No
. ..'j_01(p –
Relly
It name on record is different than that of applicant,indicate below: essed
U V p wed
(IC 6-1.1-7)
Ne of Mac y.-gee or contract setter •
Address of mortgagee or contact semi(number and street,city,state,end ZIP code)
Name o other f assignee or oth owner or holder of mortgage ' .
Address of assignee(number and street afy,state,and ZIP code) -
•
Does applicant own property in any If yes,what county? What Taxing District? Has tits deduM'm teen requested If yes,state amount of deduction
other county in Indiana? ❑YYes 0 N =rent year? ❑Yes 0 N
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 equtiy fine of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR " .
Deduction approved in the amount of:
•
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,yew)
I 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.
3.Fignatifpgropert rrAi'`� Date(month,day,Year)
Q-- f/may/
Fug resident address of applicant(number and street city,state,and ZIP code)
700E tAlnt,f Si FA- gram r 1764 >
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,yea)
Address of authorised person (number and street 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.