HomeMy WebLinkAboutMortgage_Greenwell STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
it FOR DEDUCTION FROM ASSESSED VALUATION
':._ '� State Form 43709(R13/10-15) .'
Prescribed by Department of Local Government Finance )- ice.
INSTRUCTIONS: :P' lie Mark
To be filed in person or by mail DEC 99 pU Fo filed with:
Filing Dates 1) Real Property:Must be completed and dated in the calendar year for which the deduction rs sNt/ginc u I�1 �( �{
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is / Lt. County Auditor
located on or before January 5 of the immediately succeeding calendar}rear.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with th Cp : ..'--:y�y ;.-.-• ❑ County Recorder
where the properly is located during the t1ve/va(12)months before March 31 of eacltry'�a •=.l. f••is sought.
See reverse side for additional instructions and qualifications. 1 AUDITnR
Applicant(owngw conq�a 6aryer rA asfbic6'ons on rave side) / s y bazazarfi
Taxing D Key number/ description Record number Page number
.96-/y _ AR- _ Ao/ oo/./y!o oa (o RU/ 3 a 856
Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment dale,aurentyear assessment as ,current year date of application legal or equitable owner?
b6 � ❑ yes 0 N
If no.what is his I 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 helm! Is the property in question:Annually Assessed
❑Real Property ❑ Annually Assessed
• Mobile Hoare(IC 6-1.1-7)
Name of mortgagee or contract seller
8
Address of mortgagee or contract seller(number and sheet city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage _ -
�cee����� 4-
Address of assignee(number and street,city,state,and LP code) l Y`
((y �re�n .ZtAk A
Does applicant own property in any If yes,what county? What Taxing District? �Q..h� . ` ' of deduction
other county �yyy�,
in Indiana? ❑Yes 0 N 01 1 a •t Ov.n
A person is not entitled to this deduction unless the person has a balance on the pert \cA •in the county
recorder's office(including any home equity line of credit that is recorded in the cola. .b O O o .OO S-31-13
COUNTYAUC ,a,0 `�- a7 SO
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 I contract buyer of the aforementioned property on date application is filed.
Signatu a(owners MI name) Data(month,day,year)
Full resident address of applicant(number and sheet,city sate,and ZIP code)
go 9- rnoI\at .('c Or
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day.year)
Cor f- Ar..r- c-i"-- j/l) Ar /6 'r 2i
Address of authorized person (number and sheet 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.