HomeMy WebLinkAboutMortgage_Lemmons — STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'frt FOR DEDUCTION FROM ASSESSED VALUATION
-R= 't'` State Form 43709(R131 10-15) D
S Prescribed by Department of Local Government Rnance
INSTRUCTIONS:
Tc be filed in person or by mail F�Mod with:
Filing Dates 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought FEB I(
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 immediatety succeeding calendar year. II ,.
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the •. 1-*-.1 ,i_
ecerder
where the property is located during the twelve(12)months before March 31 of each year the ded . ,ill° 7H-'
See reverse side eeforadditionalinstructionsandqua lifcations. • ' •UNTYAUDITOR
Applicant(ow confraG buyer sKrym oar' son - side)
Tars"iict Key number!legal description Record number Page number
(�oC� , (74, - /3 - 23 - 10/ - oot. g )._ 3 -ooL 07 SII3
Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant the sole
assessment date,arrrent year assessment date,current year date of appli ati/cal, legal or equitable owner?
7/ 0t7O ❑ Yes ❑ No
If n o,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 quest on:Annually Assessed
❑ Real Property ❑ Annually Assessed•
�1// n1 �y1 �-�t bbbl7e Home(IC 6-1.1-7)
Name of mortgagee or contract "-en( / r r. 7J- 1 .'60 '—
Address of mortgagee or contact seller(number and sheet city,state,and ZIP Ccode)
Name of assignee or other owner or holder of mortgage - - _
DrafYCr tr -N .
Address of assignee(number and sheet city,state,and ZIP code) - '•'••••.•
. Card No. OR_
Does applicant own property in any If yes,what county? What Taxing District? Has th ••...-51 /3
other county on pm
in Indiana? ❑Yes ❑No currer '-'/7 —
A person is not entitled to this deduction unless the person has a balance on the person's mortgage.., __ 7 3 J-C
recorder's office(including any home equity fine of credit that is recorded in the county recorder's offke)that is the uaa,..- v
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!contract buyer of the aforementioned property on date application is filed.
XSignature(mpreYS futIname) Date(month,day,year)
Full resident add of number and street,city:state,and ZIP code) ,(
A /q‘2-57 C4/101 (sit� Ai/as "29 O.('i'r)(.,CO cj)t-7 j4✓ Y7 C''
Person authorized by duly executed Power Attorney or by IC 5-1.1-12-0.7 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.