HomeMy WebLinkAboutMortgage_Willis (2) �s'�. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNErirn�ry-.�ijownship Year
L:'t.' .:. L{
�.�:. FOR DEDUCTION FROM ASSESSED VALUATION
•%,-:_ State Fonn 43709(R13 t 10-15)
� Prescnbed by Department of Local Government Finance
•
INSTRUCTIONS: MAR 6 2017 File Mark
To be filed in person or by mail. Form filed with:
Filing Dates- 1) Real Property.Must be completed and dated in the calendar year for which the deduction i right
Must be filed or postmarked with the County Auditor or County Recorder of the county wl ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year ing eG�n'r ('� County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the C''oymry9MIi eTohliDITO R❑
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
AppB t(owner orct buyer
T D" buy er-seere " ' on reverse side)
_! yneLteeetJX
Key number/legaaI description
Record number Page number
A 6, // - o/ — /00 •• 00e . /4 ,9 -o a7 0101 sacrs7"
Assessed value of real property a5 of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole •
assessment dale,current year assessment date,current year date of application legal or equitable owner?
•A7 60 b ❑ Yes ❑ No
If ro,what is his I her exact share of interest? If owned with someone othir than spouse,indicate with whom
If name on record is different than that of applicant indicate below: 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 contract seller(nu and sheet,aty,state,and ZIP code)
Name of assignee or otter owner or holder of mortgage .
A
press
of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? Mat Taxing District?
other county \ 1
in Indiana?
Dyes o ---c- �, C /\�\ C �r�e \c -.
A person is not entitled to this deduction unless the person has a balance on the `C't, \
recorder's office(including any home equity line of credit that is recorded in the a 1 ) . 1 " "1 " 1-1 b o O.,O O
YJ 1 ` IS
COUNTY A
Deduction approved in the amount of \a- (3• RC'
20 20 20 20
Signature of County Auditor County • Date(month,day,yew)
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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 1 contract buyer of the aforementioned property on date application is filed.
,( Signatwe owners full name) // Date((nn,ur.th,day,year)
Ut ,fu71I`IJ3, �applO bera+nd street, state, ZIP code)Kr!/)titian f4j. 'nil X Person authorized by duly Vexearled Power of Attorney Er by IC e-1.1-12-0.7 / ` `�Date(month,day,year)
sp1/4.Atldress of authorized person (number and street crfy,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.