HomeMy WebLinkAboutMortgage_Hillyard (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION County Township Year
' Plats Form
be 43709(R13 m 10-15)
o County
T —'
cop Prescribed by Department of Local Government Finance �,�
INSTRUCTIONS: - File ark
To be Filing Dates:s in person or by mait Real Property Must be completed and dated in the calendar year for which the deduction is sough.E C 2 9 201 i Form filed with:
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ..
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Cou Auditor s .rf r County Recorder
where the property is located during the twelve(12)months before March 31 of each year t•.n,rf.-it rrft/flr
See reverse side for additional instructions and qualifications. .�' ' AUDITOR
?..(owner or contact buyer-see restrictions on reverse side)
/YY�C/a Y1t-&C 11-e.t fi
strict Key number/legal description Record nunger Page number
l-tska?J rz6-- / a — o7 - 40 / - 66I. / 8Y-01- S /11 c{ , 53
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Cont ed indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of appr legal or equitable owner?
40 CO6 0 Yes 0 No
If no,what is his I her exact sham of interest? If owned with someone other than spouse.intricate with whom
If name on record is different than that of applicant,indicate below- Is the property in question:Annually Assessed
, 1Ifeal Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller
Address of mortgagee or contract seller(number and street.city,state,and ZIP code) 1-111.L.. nn p
Y/Y�Q .54/y1g3
Name of assignee or other owner or holder of mortgage / / 4 1 Mia1/4et— —
Adder�p f assignee(number and street city,state,and ZIP code) I q- 7 53
YT SE 7- A - /a , i6 4-1.
—
Does applicant own property in any If yes,what county? What Taring District? Has this dr
other on propert
in Indiana? Yes ❑No current ye: _
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recomed in we Gunny
recorders office(including any home equity line of credit that is recorded in the county recordeCs 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)
•
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.
v1 Signature(owner's futI name) liar_ Date(month,day,year)
Full r ent atltlress of applicant(number and sheet,dry;state,and ZIP code)
5109 5. 5144 1,./4-61-) Sr Ph../vcLTvi/ zit y2na
Person authorized by duly executed Power of Attorney or 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.