HomeMy WebLinkAboutMortgage_McConnell STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
;_-.-, ^ FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
�— Presaibed by Department of Local Government Finance
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INSTRUCTIONS:
Fu I :'I
To be filed in person or by mail. — •° ter
Filing Dates 1) 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 properly is M, B0gNAuditor
located on or before January 5 of the immediately succeeding calendar year. e7Couunt l Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the properly 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. I '. ',IMj.
Appli town argoghds;lwyer-were '
• on( l side)4 sr Echo GltfbON COUNTY AUDITOR
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T ig District' Key nu1w- /legal description Record nu Page number
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value of�lmpert as of /ret�indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole application legal or equitable owner?
/00, OCCC ❑ 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 belay. 1 Is perty in question:Annually Assessed
— '7Real Property ❑ AnnuallyAssessed
Mob de Home(IC 6-1.1-7)
Name of mortgagee or contract seller
_ Drawer NO 06' 1— 7ithdt_C-
Address of mortgagee or contract seller(number and sheet,
Name of assignee or other owner or holder of mortgage Card NO. /094)
Address of assignee(number and sheet,city,state,and Zlf (' �(o, ba a � 245(1- ,
. owe-
Does applicant own property in any If yes,what county? What Taxing District? Has tmsbeaucuon oeen requested If yes,state amount of deduction
in Indiana? ❑Yes ❑No I I currenprnt property for r ❑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)
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?contract buyer of the aforementioned property on date application is filed.
Signature "°�e) Date(month,day,year)
AO 77-a:21
F r adtlress a hcant( her and street any,state,and ZIP rodeo)/ �/ 41712O V001
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Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 r 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.