HomeMy WebLinkAboutMortgage_Auberry a) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
i' "` T FOR DEDUCTION FROM ASSESSED VALUATION
� '° State Form 43709(R13/10-15)
- Prescribed by Department of Local Government Finance FILL ;1
INSTRUCTIONS: Y '�"`'
To be filed in person or by mail. Form filed with:
Filing Dates' 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought Dpr 2 9 r rug be filed or postrnadred with the CountyAudito-or County Recorder of the county where the proper&ig ,e3 County Auditor
boated on or before January 5 of the immediately succeeding calendar year. • Cou r ty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must We with the County Auditor of the •% nty. r �l
where the properly is located during the twelve(12)months before March 31 of each year the deduction Mi.,•ri y �T1r^ r
See reverse e addi�tionnal linstructionsandquaffica
y Record number Page number
6- a-0'! io .3-66o• a .a°22 2&/ 5Y7S--
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of 1 Is the applicant the sole
assessment date,current year assessment date,current 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
tf name on record is different than that of applicant,indicate below Is property in question:Annually Assessed
• Real Property ❑ Mobile (IC 6
� Mobile Home(IC 61.1-7)
Name of mortgagee or'�' - - D- `/ .^.// 11 2j164-2
Address of mortgagee or contract seller •= and scree sty,state.a LP code) W� — _------
F\ d
Name of assignee or other owner or holder of mortgage t f U-/V tr'1 —
Address of assignee(number and street,sty,state,and ZIP code)
o�applicant own property in any If yes,what county? What Taxing District? Has this deduc a 0 (,p S��S
county property for
in erian is ❑Yes ❑No current age �- "
A person is rrot entitled to this deduction unless the person has a balance on the person's mortgage or
recorder's office(including any home equity line of credit that is recorded in the county recorder's otfio[
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County • Date(month,day,year)
I 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 t contract buyer of the aforementioned property on date application is filed.
/ Signahrr (owners lull name Date(month,day,year)
Vh � Q.11 b
Full resident address of applicant(number and strae;� ,state,and P code)
t 'jr2- q (�. nA°Cl-il rt 3t AP code)
, 7'/J - y7(o70
Person authorized by duly executed Power of Attomor by IC 6-1.1-12-0.7 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. .