HomeMy WebLinkAboutMortgage_Beadle STATEMENT OF MORTGAGE OR CONTRACT INDEBTED I County Township Year
ff,_ FOR DEDUCTION FROM ASSESSED VALUATION
tr..,';' ° State Fonn 43709(R13/10-15) ( l :4
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Presed by Department of Local Government Finance •
INSTRUCnoNS: DEC 28 - File Mark
To be filed in person or by mail. 1016 Form filed with:
Filing Dates' 1) Real Property.Must be completed and dated in the calendar year for which the ded •-•A is sought
unty Auditor
Must be filed or postmarked with the County Audrtw or County Recorder of ftj�lie cou ;%re th�• •�, is tY
located on or before January 5 of the immediately succeeding calendar yea)?IB$ yaw County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Coy ' -tie:• a��y]t,r- nunly
where the property is located during the twelve(12)months before March 31 of each year the..:.)/?l;. A-.. et.
See reverse side for additional instructions and qualifications.
Applicant(owner wy9n a buyer-see restrictions on rse side)
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Key number/legal description number Page n ben
aL- a-07- aaiaoi. r7LLLL6- FCOaS� o/
Assessed value of real pwperty as of assessment de e,cement year date of application legal or equitable owner?
❑ Yes ❑ No
If no,what is his/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. Is the property in question_Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee o'contract seller /01 ,,1// l9
Address of mortgagee or contract seller(number and store;city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,sty,state,and ZIP code)
Does applicant awn property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county , property for
in Indiana? Yes ❑No current year? ❑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 hone equity fine of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduct --.•` _ _
C- qJ0 . W/ .
2 DI a”el- NO.,OI 20 20 20 20
Signs
County Date(month,day,year)
— Card N 5115
1/ O• •••.•••.:5........
d foregoing information is true and coned and that the applicant is a resident of Indiana and
rn..._..
ate application is filed.
Signature(owner's• r e) Date(month,day,year)
Full resident ad• of a ficant(number and street city,state,and ZIP code)
(!ell 4o Si. , fr;nce , =1n Y7670
Person authorized by duly executed Power of Attorney or by IC 6-11-12-0.7 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$x9,&O .
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