HomeMy WebLinkAboutMortgage_Raley STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
• Stale Form 43709(R13/10-15)
Presabed by Department of Local Government Finance i.. ,t
INSTRUCTIONS: i i ill
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 sought � II AA
Must be filed or postmarked with the County Auditor or County Recorder of the courtly where the propertynS N I , ®I county Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the co. , County Recorder
whew the poperty is located during the twelve(12)months betas March 31 of ead7 year the dedrx7iai: ',.r .% grrmli
See reverse side\11for 6aaddibonal'- s and qualifications. GIRSOMCOUNTYAlrui K
Applicant(owner ba r G> - .en on reverse side)
e. 1...1.. Key number/leg:. •-.' Record number Page number
I a(� � c 11-- 6--1o(.oa-f-.(,L200 ,z of (0 5 Z 7 ?
>,value of real property as of Mortgage indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessrreM date,anent year wrrent year date of application legal or equitable owner?
nett) ❑ Yes ❑ No
If no,what is his/her exact sham of interest? I If wined 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:Annually Assessed
❑Real Property ❑ Annually Assessed
-- Mabee Home(IC 6-1.1-7)
Name of mortgagee or contract seller I �"+"`�e S —
Address of mortgagee or contract seller(number and et,city,state,and ZIP code)
rr c" �r t\ComC 2 noY`
Name of assignee or other owner or holder of mortgage �i �l v (LC
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Address of assignee(number and street,city,state,and ZIP code)
;-0 ( L - S 1 9 \1- 15' IL
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested a .r--..---_- ion
other county on property for
in Indiana? Yes ❑No current year? ❑
❑ pr
Yes ❑No
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
recorders office(including any home equity line 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
Sigratu my AUditOi County - Date(month,day,year)
f7��� MA o ' u �
We certify under the penalty of perjury that the a v a regoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signature(owner's fug name) Da(month,day,year)
\i10 %.1 wn_
Full resident address of ap ((number and street,city:state,�and ZIP code) l
)-L6Y Li -)1il 11c -Pei'nrr Ft -The;An., `11170
erson authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,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.