HomeMy WebLinkAboutMortgage_Lanham �.,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
i`. i FOR DEDUCTION FROM ASSESSED VALUATION 1.41
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State Forth 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: ii[ `2017
To be filed in person or by malt. o fled with:
Filing Dates: 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is itor
located on or before January 5 of the immediately succeeding calendar year. 7J�I(! C ty Recorder
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of tlg FBSaN COUNTY AUDITOR
where the property is located during the twelve(12)months before March 3 o each year the deduction is sought
See reverse sid' • additional instructions and qu ns.
ADWi0> but side) /f /
Taring:".C� /J ,//L/ Key /legal descn� r`f�// R number Page mbar
Assessed value of real property as of Mortgage t Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
d
assessment date,current year assessment date,current year date of application /0 legal or equitable owner?
Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse," " to with whom
If name on record is different than that of applicant indicate below: Is property in question:Annually Assessed
Is
Property ❑ MnuallyAssessed
SC-
Address • // -- Mobile Home((C 6-1.1-7)
Name of mortgagee or contract seller /a?
of mortgagee or contract seller(number and street c1iy,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code) 2 >16--
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
in Indiana? CI Yes ❑No current year? ❑Yes El No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
yt ' r I'/� S/��/C�_(,/ Q -- COUNTY AUDITOR
De L/3N Hain / //I�'
Kelly j µ 20 20 20 20
Sy /� 'L�/Y//11� County - Date(month,day,year)
I . __-_ _..__. _. ..a„r„t ycgwy war me aoove and 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.
Sig re
/ re(owner's full name) �j �; '/ ,, ,, ,Ja/�n ) )�r� Date(month,day,year)4, ca.iii_a-rvi
, '7 / e* ��-Kt l city,
/(X U'��`e)/1-/ti `f” /�O‘DO l - JO-!7
Pert authorized by duly executed Power of Attorney or by IC 6-1.1-12-03/ 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.