HomeMy WebLinkAboutMortgage_Mitchell . STATEMENT FOR DEDUCTION OF MORTGAGE FROM ASSESSED OR CONTRAVALUAT CT ION INDEBTEDNESS County Township Year
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;-_ '^ State Form 43709(R13/10-15) I
Prescribed by Department of Local Government Finance =a �' uu- +/k- -
INSTRUCTIONS:
To be filed in person or by mail. F rm filed with:
Filing Oates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought JAN 1 .7 ./�pU-�7
Must be filed or postrnarked with the County Auditor or County Recorder of the county where the properly is LJ 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 County Auditor ofth: 14.1 1 ' i County Recorder
where the property is located during the twelve(12)months before March 31 of each t::'."it -fly,
9 ( ) year
See reverse side for additional instructions and qualifications. • , • NTY
AUDITOR
AppficanJ' or-contractbuyer- .49 nsonev� fie 779/7'
Taxing Disbicl Key nu:24gal description ��/`'/j/_J /1 7 rum Page number
Assessed value of real property as of 07 Mortgage Con a indebtedness unpaid as ".CMortgage 0tract indebtedness unpaid as the applicant
assessment date,anent year assessment date,current year date of application in legal or equitable owner?❑ Yes ❑ No
COD If no,what is his 1 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 �-//[j n
Address of mortgagee or contract seller(number city, tes code) �(/�
Name of assignee or other owner oliortg
'`7C//n/ SR/7E, / r.�-
Address of assignee(number and bet 42,e,and ZIP and
74 (72/IC�lY/�1 !/a/ O,Sdgv° c/L//l11wi� me /-/D .c7�`9&
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ❑No current year? ❑Yes ❑No
F- `- -"-"•r^dab rtinn unacs the person has,a balance on the person's mortgage or contract indebtedness that is recorded in the county
n /(�� rr, ^�pp -� i recorded in the county recorder's office)that is the basis for the deduction.
l.�tiLY,k`i� (C %� COUNTY AUDITOR
i /Y)
// / - 7l5 20 20 20 20
County - Date(month,day,year)
. ...-.... _..__ __ _ d foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sly,e(owner's e) _ - - - - - Date(month,day,yea
Full resident address of applicant(number and street city,state,and ZIP code)
1- GZ88 A/- �2 65 !/Zit//(rf■), li0 7o
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.