HomeMy WebLinkAboutMortgage_Smith (2) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
't€ :. FOR DEDUCTION FROM ASSESSED VALUATION
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'- State Fonn 43709(R13/10-15)
'4 .y Prescribed by Department of Local Government Finance T'' •INSTRUCTIONS: - ' 'ZY P'
To be feed 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 MAR 2 r �p.�
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is q J,7 County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the!I nty.
where the property is located during the twelve(12)months before Marsh 31 of eat year the%%on - :.:..r�.-.jr�;i
See reverse side for additional instructions and qualifications. `�rtlSON COUNTY
APPg t( buyerAsee m.�m,ctarh' n reverse side) AUDITOK
Taxing District Key nu /legal description Record nu r Page number
d& - /3 -36 - 9DV •000. 02 89-009 I 1309
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,amend year assessment date,current year date of applicatbn legal or equitable owner?
CO 9/o0 ❑ Yes 0 N
If no.what is his/her exact share of interest? If owned with someone other than spouse,indicate with wham
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(numberE—__"_ -" -1
ao R -130`1
Name of assignee or other owner or holder of nor
l.1.4-.∎"-Sr.: C .°I3CSSILg. k
Address of assignee(number and street,city,stab �y„�;*�L -.o cA1 S \ - o
Does applicant own property in any If yes,what 4 S O G O. a 3 on been requested If yes,state amount of deduction
other county I f
in Indiana? ❑Yes 0 No - ❑Yes 0 No
A person is not entitled to this deduction unle .,_ 19 - I� =tract indebtedness that is recorded in the county
recorder's office(including any home equity. I 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 corned and that the applicant is a resident of Indiana and
owner/contract buyer of the a rementioned property on date application is filed.
�Signe (ownetytlt
Data(month,day,year)
if • ant afddress of app t(n and street,sty,state.aqd 7� atde`k l.10 7 CD 7 - Y 7 & 39
arson authorized by duly executed Power of Attorney or by IC 11-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet cry,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a hat years and a fine not to exceed$10,000.