HomeMy WebLinkAboutMortgage_Pennington a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-4..t-Vi: FOR DEDUCTION FROM ASSESSED VALUATION g
'- State Form 43709(RI3/10-15) Bl
`- Presalbed by Department of Local Government Finance
INSTRUCTIONS: DEC 2 ' . '
be filed in person or by mail. F!'' "
To witlm:
Filing Dates: 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 properly: ❑ • •. ' •itch
located on or before January 5 of the immediately succeeding calendar year. lirna•unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor• •- -ft : I II -
where the property is located during the twelve(12)months before March 31 of each year the ded,., f.�.: .,4 u .
See reve side for additional instructions and qu ' ns.
Applicant... er or contract buyer-see re rse side) •
0A /umber `�,-,1-� �� co � 609 0
laxn•II / I(O- dial description - bat/. L tJ T number Page nu. be
a Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,cumuli year assessment date,current year date of application/, legal or equitable owner?
❑ Yes ❑ No
If no,what is his r 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 property in question:Annually Assessed
Real Property ❑ Annually Assessed
fl ' � �. Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage ����1111
Address of assignee(number an ,arm code) �! �/'
O Cyr �6 - 03- // . no eAc
D'
Does applicant own property in any I y I county? What Taring District? Has this deduction been requested If yes,state amount of deduction
other on 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
recorder's office(including any home equity line of credit that is recorded in the county recorders office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 • 20 20
Signature of County Auditor County • Date(month,day,year)
k, I/We certify under the penalty of perjury that the above and foregoing information is true ant"— - d
l\�1 owner!contract buyer of the aforementioned property on date application is filed. 1a0�V h c Qc.v..v.l1��Q tti. ip
^,Sig�]°'�re�owners Gill \- - 1 r 11 I J
W via cold Sit plA 7i n c k3o-w _
Furl resider=c4 applicant(nurr(er and street,city,state,and ZIP code)
Sn wsTApt t2 5( is 0,3:.) —
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
Dolt, - S "I
—
Address of authorized person (number and street city,stare,and ZIP code) ; I - R,
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. •