HomeMy WebLinkAboutMortgage_Lamb , , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Form 43709(873110.15)
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-� Prescribed by Department of Local Government Finance AILED
INSTRUCTIONS:
To be filed in person or by mail. DI FLnnfled y16
Filing Dates: 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought i• 6 / C
Must be hied or postmarked with the CountyAudrtor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediatety succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CotmfyAuditor of the county I t ❑v= -:!'"'-'•er
where the property a located during the twelve(12)months before Mardi 31 of each CO I Y AUDITOR' ns. ' ° OUNTY AUDITOR
Ma O off contra"buy
91- (g /Aifcsc2 _ 62-71 Z
Ara TAI - / A d -�d •2� add da ��� 5l
• _--, value of mil property as d Mortgage!Contract-indebtedness unpaid as of • Mortgage I Contract upgh4adness unpaid as of Is the app n1 the sole
roac-asue.ddate,anent year assessment date,cement year date of application legal or equitable owner?
af7� 039 ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than cproico,indicate with whom
If name on record is different than that of applicant,indicate below Iss the property in question:Annually Assessed
• /Real Property ❑ Annually Assessed
`�/I�� Mobs Home QC 6i1.1-7)
Hare of mortgagee Of contract seller - OezzM
Address of mortgagee or wtBd seller(number and street,city,state,and ZIP code)
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Name of assignee or other owner or holder of mortgage •
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Address of assignee(number and street cdy,state,and ZIP code // nn // / qx ,r Do es appfimnt corm property In any Oyes,what D � ..C/ /Won /G�� n
other dla county? ❑Yes ❑No - �aarent year? ❑Yes CI 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
recorder's office(Including any home equity fine of credit that is recorded in the county recorder's office)that is the basis for the deduction.
_ COUNTY AUDITOR '
Deduction approl- - —
/n� 8 JoSN u A LL)
20 Ll7m / !0 20 20 20
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Signature of Cow /,, County Date(month,day,Year)Yea
^. I I We certify I _ "' I information is true and correct and that the applicant is a resident of Indiana and
L�1 amer I contr. don is fled.
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signatures(on u name) "�'��- Date(month,day,year)
Full ,resdent address of applicant number and dty,state,and ZIP code)
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Person authorized by ruby executed Power of Attorney or by IC 61.1112-0.7 Date(month,day,year)
Address of authorized person (number and street Cry.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.