HomeMy WebLinkAboutMortgage_Burns (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township
fj ry p Year
'!_-�:� FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13 1 10-15) F
1
"--r— Pre d by Depar tment
of Local Government Fnance
•
INSTRUCTIONS: t e an
1)be filed in rson or by mail.Filing Dates:1) Real Property:Must be completed and dated in the calendar year for which the dedudmn is sought FEB 2 4 Z filed`ith:
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. 171:2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor ofth. ::..;,• ynrAii; aunty Recorder
where the property is located during the twelve(12)months before March 31 of each year the•e..:•4 R tret4TY AUDITOR
See ret tional f qualifications.
nSe,htrumm��on reverse ppyypp�nn Taring 7 i j7 /0�'6OQ. /"6"6 inn ��n��
Assessed value of real property as of tea! Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole -
assessment data,current year assessment date,current year date of application legal or equitable owner?9
❑ Yes ❑ No
If no,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 th property in question:Annually Assessed
eat Property ❑ AnnuallyAssessed
/�/,)o//� ill �jy ,,�///"/� Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller , /\r"N e `�F- rl�f4-�`
Address of mortgagee or contract seller(number and street City,staP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,illy,state,and""'- - —__
N
Does applicant own property in any If yes,what count p �` a� 1 \ rquested If yes,state amount of deduction
in Indiana? ❑Yes ❑No "4.' K "-N^�,` ❑No _
A person is not entitled to this deduction unless th '° 9 a a. O Zlt_ 1, 'ndebtedness that is recorded in the county
recorder's office(including any home equity line o 1 11`• he basis for the deduction.
Deduction approved in the amount of U `�_ ��
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
• '-r I contract buyer of the afo -mentioned property on date,:••lication is filed.
iis y-• re(owner's e) / Date(month,day,year)
Al 't.,..� S , . JIL006
Person a •orized by duly executed Power o Attorney or by IC 6-1.1-1 �J 1.1-1 / Date(month,day,year)
Address of authorized person (number and sheet 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.