HomeMy WebLinkAboutMortgage_Hull s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C0U i Year
'1t' ,_r. FOR DEDUCTION FROM ASSESSED VALUATION g1./
t.` State Form 43709(R13 1 10-15)
St's Presaibed by Department of Local Government Finance �eI Mm,k
INSTRUCTIONS: MAR le Mtlf i 7
To be filed in person or by mail. Form filed with:
Filing Dates 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought A
Must be filed or postmarked with the County Auditor or County Recorder of the county where the prope r ii �, Z."— Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditorg§i§airigO UN T �voty Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought FOR
See reverse side for additional instructions and qualifications.
ncaner orry/was see on reverse side) �dy� �/f
` Y payerSi' sa' S ti i o_
africt CY—I ` / n Page number
��Q d //—/ —77 OO. cod?24'/-0017 G .�
ccnesen value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the
assessment date, ear assessment data current year date of application //', yn v^/ legal orequ�blthe ownne?
cb I (• ❑ Yes ❑ No
If no,what is his/ter exact&am of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below. th pert in question:Annually Assessed
eat Property ❑ AnnuallyAssessed
//�� Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
/4141 .41- 7-0--` , „/
Address of mortgagee or contract seller(number and abeet city,state.and ZIP code) /y/{' '
Name of assignee or other owner or holder of mortgage
Address of assign Ober and sire �r(�y/� � CMS—13 qtr es state.`on .aC ' �Ct3 / o`—// �9,9-e
Does applican r many/ Iff yes,what county? What Taxing District? Has Nis deduction been requested If yes,state amount of deduction
other county property for ❑imindia Yes ❑No current 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,year)
1' I/N V �q ( ` C J �^ :going information is true and correct and that the applicant is a resident of Indiana and
(I1� Drawer NO 0 ppticationisfiled.
Signah Date(month,day,year)
Fug re
Card t\7 O' de)
P /.370/ 3- °Len s- -• •IV V..y , r) O
Person authorized by duly executed Power of Attorney or by IC 6-1.{-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.
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