HomeMy WebLinkAboutMortgage_Hyneman (3) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. FOR DEDUCTION FROM ASSESSED VALUATION Y
'° State Form 43709(R13l 10-16) e
Prescribed by Department of Local Government Finance ge
File Mark
INSTRUCTIONS: r
To be filed in person or by mail FEB 9 2l Om filed w :
Filing Dates: 1) Real Property.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 properly is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ri a County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of it.-. n4jmff►,
where the properly is located during the twelve(12)months before Mardi 31 of each year thgsisopp 6_., y AUDITOR
See reverse :.e for additional instructions and qualifications.
Appbcan . er or contract -see re n rse side) fp
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Key:lumber/ al descn Record number Page number
i:... 4,L� C 51-N36 e- •:,.•.�, '-QG9 4G Y ,Vi
Assessed value of real property as of I Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment dad,arrant year I assessment date,current year date of apptkation legal or equitable owner?
O ❑ Yes ❑ No 000
If no,what is his I her exact sham of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate belay. Is the property in question:Annually Assessed
$Real Property ❑ Annually Assessed
/\ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller -
Address of mortgagee or contact seller(number and street oily,state,and ZIP code)
Name of assignee or o holder o age 2_r , . ' I W,0 &a J� /) S^^
7 (/�/CJ"//J Sao
Address of assignee(numb= .it--t city,state,and ZIP code) /
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 on property for
in Indiana? Yes El No current year? ❑Yes ❑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.
COUNTY AUDITOR
Deduction approved in the amount of.
20 20 20 20 20 20 20
Signature of County Auditor County - 'Date(month,day,yeah
-
43 I l We certify under the penalty of perjury that the above and foregoing information
Drawer I•a 1ye r N O •C2O/h7' a and
owner I contract buyer of the aforementioned property on date application is filed. •/•••.....
•
le e(owner's full . e _
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P/ Card NO. .... l•
F :resident aggress of app, numbed and " stet;and ZIP code •• ••'''
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Person authorized by duly smarted Power of Attorney or by IC 6-1.1-12-0.9 ! "`�-r� 'tu.p
I
Address of authorized person (number and street city,state,and LP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000. - ._ -.