HomeMy WebLinkAboutMortgage_Patoka United Methodist Church #;� . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r�'�`.�,. FOR DEDUCTION FROM ASSESSED VALUATION
p-..t State Form 43709(R13/10-15)
`--Li-- Presalbed by Department of Local Government Finance
INSTRUCTIONS: �F - �!artc
7b be filed in person or by mail.
Filing ates 1) RealI,
n9 ) Property:Must be completed and dated in the calendar year for which the deduction is sought nnnn C�
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is JA. un Auditor
located on or before January 5 of the immediately succeeding calendar year. U Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sou ryt
See reverse -..,e for additional instructions and qualifications. OIBau y �
�`�/c�ybuyer ve ) /// / COUNTY AUDITOR
t . LG�TFJKQ+ � g L� r I 09El
- / Key caber/legal��P Record number Pagg�umber
ia_ �6 -p9-p - 3GO- OQO./3a -Da 0 11 sCGct,
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract ind ness unpaid as of Is the applicant the sole
assessment dalu,c ure�nt j assessment date,current year date of application /� legal or equitable owner?
O GL) -I'/. JO° ❑ Yes ❑ No
If no,what is his!her exact share of interest? If owned with someone other than spouse,indicate with whom
it name on record is different than that of applicant,indicate be Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 7� e n
Address of mortgagee or contract seller(number and c" Nate, //�//, .,.,/'
city,state,aM ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and Z
-
• Drawer N1O.....
Does applicant own property in any If yes,what county ''' tuested If yes,state amount of deduction
other
rot a? ❑Yes ❑No I73 —,2)<^ ❑No county
Card NO. 1``�t////
A n is not entitled to this deduction unless the �de6tedness that is recorded in the noun
recorders office(including any home equity tine of _ e basis for the deduction.
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 coned and that the applicant is a resident of Indiana and
owner I contract r of the aforementioned property on date application is filed.
Signature� ems. Date(month,day,year)
Full resident address of applicant(number and sheet,dtc state,an ZIP code)
Personauthorized by duly executed Power of Attorney or by I 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street oily state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a had years and a fine not to exceed$10,000.