HomeMy WebLinkAboutMortgage_Thomas STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
•
5'. FOR DEDUCTION FROM ASSESSED VALUATION
_ � State Form 43709(R13110-15)
Prescribed by Department of Local Government Finance FILED - File Mark
INSTRUC77ONS:
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 .
y' . tile deduction is sought
Must be filed or postmarked with the County Auditor or County Reco n^= i 1413 04M Eihere the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. ( County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must fil with the Coun Auditor of the county
where the property is located during the twelve(12)months before M 1 of a deduction is sought
See reverse side for additional instructions and qualifications.
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or �� ,,,p,- Rrreu ) OfBSON C0 JN'i r nuD'70K Cfienaer
I.LLAjj-11 �'L"(p-'(C7.�number/legal description Record ember Page number
a(O -ba; CO I-oa1/4l i10 39 s
value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,cularr date of application legal or equitable owner?
44 ❑ Yes ❑ No
If m,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 ❑ AnnualyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
4
Address of,mortgagee or contract seller(number and street city,state,and ZIP code)
/061&
artre�gnee or other owner or holder of mortgage
Address of assignee(number and street,dry,state,and ZIP code)
JO Re--- C3 9 At-6-
Has this ry amount been requested If yes,state amou of deduction
for on property f
in India current year? 1_1 Yes ❑No
A per 3rroe on the person's mortgage or contract indebtedness that is recorded in the county
records Drawer N O tied in the county recorder's office)that is the basis for the deduction.
. COUNTY AUDITOR
Deduct
Card NO.
21 20 20 20 20
Signatu a of,� /j try A .'. County Date day,ye
%,.Air I \A i C5
I/We certify under the penalty of perjury that the abSe�foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/ •1 -ct• er of the aforementioned property on date application is filed.
5r ( 1 • r9e) - Date( M.day,year)
- A r
/, j i// C.
Full r.-:. ad. =�o(appficant(number and ay.state,and LP code)
Person authorized by duty executed Power of A mey or by IC 6-1A-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 hall years and a fine not to exceed$10,000. .