HomeMy WebLinkAboutMortgage_Farmer (9) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
FOR DEDUCTION FROM ASSESSED VALUATION ����
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k. '. ' State Form 43709(R13/10-15)
S " Prescnbed by Department of Local Government Finance J
INSTRUCTIONS: File Mark
To be filed in person or by mail. MAR 2 ' -.I* is wbh:
Filing Dates: 1) Real Property 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 prope , i' lit Cou r Auditor
located on or before January 5 of the immediately succeeding calendar year. �� -111,17113, County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County •�.F t.-loll ,. N r
where the property is located during the twelve(12)months before March 31 ofeaUr - -
See reverse side for additional instructions and qualifications.
AppM1a. (ow..-,or contract r r-see restriction reverse side) .
r /� o. ItUQix, �` 0imaL
T- ,11w3• '•� /� Key giber/ description Record number Page number
(^J i (/Q �& 7- 60-60 o. is-act 7 do/((( /6/ S'
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of I Is the applicant the sole
assessment date,current year assessment date,current year date of application r) I legal or equitabe owner?OF Y/ ❑ Yes ❑ No ORD
If no,what is his I her exact of interest? If awned with someone other than spoke,indicate with whom
d name on record is different than that of applicant,indicate belay. Is the property in question:Annually Assessed
Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 'o ` p
E �[e
Address of mortgagee or contract seller(nun nd street,city,state,a ZIP code)
Name of assignee or other caner or holder of a // �[
OF: AT off. 0Y/- /—/v / O/6 19C
Address of assignee(number and street city,state,and
Ze
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
outer on property for
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 contract indebtedness that is recorded in the county
recorder's office(including any home equity fine 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 I County •
I/We certify under the penalty of perjury that the above and foregoing in --r-1,_^ #-�f(�m� ant of Indiana and
owner I contract buyer of the aforementioned property on date applicatiol Y y 1 1 ,1
S" re(owner's full name) .ear)
/4C--). p 1-n/um Ger�co e��� 70h
1 Full resident address 7 applicant(number and street,city.state,and ZIP code)) Q`�1` (,..// X1/7/
/r0 20 A S l'C L!/S 1 (CL`\t-v Q'4-0 r. 1 N cl- V ' I J 1 o O o rear)
Person authorized by duty executed Power of Attorney or by IC 6-1-1-12-0.7
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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