HomeMy WebLinkAboutMortgage_Finney STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C Township Year
,.1- FOR DEDUCTION FROM ASSESSED VALUATION
•,-j' :- State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: MAR QFile Mark
To be filed in person or by mail. 3 .-,(h(filed with:
Filing Dates: I) 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 pro.��; is ID County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Au&6BBmp)Qayq, vir7/,rL A C my Recorder
whem the property is located during the twelve(12)months before March 31 of each year the deduction is s�S s:•• ry • . .l TOR
See re ------side for additional instructions and qualifications.
'owner or contra �-seef /ictions qw rgjerse side) ,
sew/fictions
('i'�ate/I (/,�,//
��'-, Key,,33��mber Record number Page num f
let - 4, �� aft—((//k3a- o3-�O.</3-40 aro/ 2 Si.3
Assessed value of real property as of Mortgage/Contrast indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,aurerd year assessment date,=rent year date of application legal or equitable owner?
c=5"Cr-to ❑ 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's different than that of applicant,indicate below Is property in question:Annually Assessed
eel Property ❑ Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller fQ_f1 C d
1
Address of mortgagee or contract seller(number and/street city,state,and ZIPod
d
ZIP code)
Name of assignee or other a or holder of age � / ,
II i ea
Address of assignee(numb an 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 county aip r
in Indiana? ❑Yes ❑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 contact indebtedness that is recorded in the county
recorders office(Mduding any home equity tine 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_ �'1 - ._ 1 20 20
Signature of County Auditor C b2.rp,Y.� •y\�Q,V — '
G1/(� F';i�v\
c
�• � I/We certify under the penalty of perjury that the above and foregoing inform: €T c- QA j\ of Indiana and
''� owner I contract buyer of the aforementioned property on date application's f g. a U n - s ' S t I S O .Sig1nature(owners roll name
r
\
� - -
Full resident address of applicant(num i,.r and street,city,state,and ZIP code) -
F /D% ..f-dvt4 c)t4gny G"Pr f/AUf Jr*b7_7,U 17(27
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 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. _ . . _ __, ._.