HomeMy WebLinkAboutMortgage_Wright yam. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.r1*,:c FOR DEDUCTION FROM ASSESSED VALUATION
Prescribed Fonn43709(R13
Department/10.15) I�
.S Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail (' 7 � Fonn filed with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the u�11� �
Must be filed orpostm 3 arked with the County Auditor or County Recorder of the county where the property is Cunty Auditor
located on or before January 5 of the immediately succeeding calendar year. I . 4 �. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the !.._.nr j??�(,q the county
where the properly is located during the Melva(12)months before Mard(A h,_i• 'I .4.�! O& M is /9M.
See reverse side for:a.nal instructions •qua bfrcations.
Applicant(ownerorcon`_. •, :�'°
.. I:_ JA : :1i Il_� , A'A • �j�/ ggg ry��Jnb/¢
T-• • ; r / Key number! i. - IS ��• . Sel -VW R�[cr r t Jr/
.•value or property of Mortgage/Go �(ebtbtedness unpaid as of Mortgage I Conttact indebtedness unpaid as of Is the applicant the sole
assessment date,• -•year/ assessment da gar __ _ sate W aPPlKaton legal w equitable ow
❑ Yes ❑ No
U no,what is ttis/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below. I Is the property in question:Annually Assessed
a Real Property ❑ Annually Assessed
•
hd-Ook /.{"� Mobile Hoare(IC 61.1-7)
Name of mortgagee w contract seller `L'�'1C,}J,'nt4�,�'
Address of mortgagee or contract seller(number street,city,state.and code)
Name of assignee or other owner or holder of mortgage
Address o'-----_n—fin Ey 1(!/���)tM,,n� V1l��f�/I f//Tt �^(�
Does appli W 1 l t`Ir(/-- 0`^r' - l Iv Taxing District? Has this deduction been requested If yes,state amount of deduction
other coon "�IJ .�Yl on property for
in Indiana? f,, current year? ❑Yes ❑No_ _
A person is - dance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's /6- r 1,5/ ,rded in the county recorder's office)that is the basis for the deduction. '
�J / COUNTY AUDITOR
Deduction a
20 I 20 20 20 20 20 20
Sgnatur-of r.in • •'• / County .t / Date(m• yy, L
I/We certify under the penalty of perjury that the above a-I'-•oing 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.
• natur (owners fun name) I Date(month,day,year)
12 t '-f 11. ll\G bk,
WI resid t address of applicant(numbs d street city,state,and ZIP code)
5103 Si- �i LA ) OWe<1 ,&Q , btu y1lRler', .
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,yea)
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 510,000.