HomeMy WebLinkAboutMortgage_Odom (2) -
„,i-a-st„ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
--M, ,..... .t.-2- ‘ FOR DEDUCTION FROM ASSESSED VALUATION .
1)11:-.;:,-" Slate Form 43709(R13/10-15) " . .- . FiLE
---:, Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
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To be filed in person or by mall. DEC 1 IchlfadYnth:
Filing Dates: 1) Real Property:Must be completed and dated In the calendar year for which the deduction is sought.
Must be filed or posbnarked with the County Aurfitor or County Recorder of the county where the property is 0 County Auditor :
, located on or before January 50!the immediately succeeding calendar year. • aveRecorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must far with the County Auditor of the co
where the property is bacated during the Melee(12)months before March 31 of each year the dedetratToelgiDUN I Y AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner contract buyer-see ipsifi•-Oitions on reverse side) - • -
0 L-Al C2L.T..4 a0a.a—h_Th
Taxing District _I Key number!leAdescription Ftecord number Page number
titZ)tn—is ,, ss0-(.0 -- 1,Z'' 1 a— Lt CYa '' C)0 00 .5-LP^ orl G ,;) b I Lp- 5 0 1
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of Is the appficard the sole
assessment dale.current year assessment date,=mint year date of application legal or equitable owner?
L2 5 I—1L- D rYes D No
If no,what is his!her exact share of interest? J If owned wIdi someone other than spouse,indicate with whom •
If name on record is different than that of appricant,indicate below: Is the property In question:Annually Assessed
Real Property ID fsruv-Thewsessed
---- vne(IC 6-1.1-7)
Maim of gee or contract seller _
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Address mortgagee or contract sae/(number and street,city,state,and ZIP code) ,
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Name of assignee or other owner or holder of mortgage ' _-- 0\'
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Address of assignee(number and street,thy,state,and ZIP code) • \L"c2
. 5(Th 5 tl Ca-
Does applicant own property in any If yes,what county? . What Taxing District? Mast \La-- ,0 „aunt of deduction
other county , cm prc n 0 `..-
in Indiana? LJ Yes 0 No - current Or- 0.e-3
M ,
A person is not entitled to this deduction unless the person has a balance on the person's mortga, 7 koS k ,ress that Is recorded in the county
recorder's office(InClUffing any home equity fine of credit that is recorded in the county recorder's t I' ..oasis for the deduction.
COUNTY AUDITOR • . • "
Deduction approved in the amount at
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. .
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20 20 20 20 20 20 20
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Signature of County Auddor County Date(month,day,year) -
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.
fra ) Date(month,day,year)46-
,ettfc resident add of applicant(number and street,city,state,and ZIP code)
"elo7 1 gt4e 5r, Fear eigkucil 2d 4,174 Ti'
Pelson authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized 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.