HomeMy WebLinkAboutMortgage_Rawlinson STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION �( �
State Form 43709(R13 110-15) A� 1. `}D�
Prescribed by Department of Local Government Finance / /
INSTRUCTIONS:
File Mark
To be filed in person or by mail. F!'- 7..riri .. I I
Filing Oates- 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is P County Auditor
boated on or before January 5 of the immediately succeeding calendar year. 4 •
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the counttyy.�..�—� '" •`�'��'�:is rder
where the property is located during the twelve(12)months before March 31 of each year the deduction is sordpfCS 4 ' - • - . - • • I I .
See reverse for additional instructions and qualifications. /�
Appfican ( er contractsee restrictions on reverse J / I
Taxing District (/C).[.�P-.) Key nnummber_//legal pfion /`llx/ Record ruber Page number
d‘-ohs-"° a-ado. ate l0 glib"
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract ind tedness un as of Is the applicant the sole
assessment date,current year assessment date,current year date of application n �1 legal or equitable owner?
�ord , 7 t.J ❑ Yes ❑ No
If no,what is his/her exact store of interest? If vaned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below- Is property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller
•
Address of mortgagee or contract seller(number and stye te,and code)
Name of assignee or other owner or holder of mortgage (�11 t�
Address of assignee(number and street,city,state,and ZIP '��'2-'u
Does applicant own property in any If yes,what county? t C2() ((9 —5 l 69 i requested If yes,state amount of deduction
other county DI':111'C I- NO
in Indiana? ❑Yes ❑No _ •/ s ❑No _
A person is not entitled to this deduction unless the pt ce 5)c((o. ). lot 1 indebtedness that is recorded in the county
recorders office(including any home equity line of at Card NO. ;the basis for the deduction.
CUUN I I AUDI I Urt
Deduction approved in the amount of
20 20 20 - 20 20 20 20
Signature of County Auditor County • Date(month,day,year) •
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 l contract""b r of the aforementioned property on date application is filed.
tat 5 n )a, ti.„....„ Date(month,day,year) ,
Full reside t ad \)o( pant(number an steel iu and ZIP e)1,
1/ VV
(v Person authorized by duly executed Power of Attorney or by IC 8-11-12-0.7 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.