HomeMy WebLinkAboutMortgage_Ota w„. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS un Township Year
FOR DEDUCTION FROM ASSESSED VALUATION g
�' State Feml 43709(R13/10. 1
15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: . ZOli File Mark
lb be filed in person or by mail AP R 1 3 Form filed with:
Filing Dates: 1) Real Properly Must be completed and dated in the calendar year for which the deduction is so gh
Must be filed or postmarked with the County Auditor or County Recorder of thee,.urrly -r'_i"'property is ❑ County Auditor
boated on or before January 5 of the immediately succeeding calendar year ti, :/'>mp' R
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with tti r irra •- • •fl Qoanty ❑ County Recorder
where the property is located during the twelve(12)months before Maria/Sf 9 s o - - :deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner •.0 buyer-see rRSnUicdarrs on r8verse� e]`_�
among v__ �/nlc Key/numberr/r\Jlegal desaiptionn•C]/� Record number Page number
"�% I cR - 49 0 / � oa 3OI aol1 T5 („d
ue of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract ind ness unpaid as of Is the applicant the sole
as tt date,anent year assessment date,current year date of application legal or equitable owner?
do? 5Q6 ❑ yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,inchoate with whom
If name on record is different than that of applicant, ndirate below Is the property in question:Annually Assessed
I
p Real Property ❑ Annually Assessed
• Mobile Home(IC 6-11-7)
Name of mortgagee• •-ntrad seller
Address of mortgagee or contract seller(number and'--t dry, te.and 4'code) --
Name of assignee or other owner or holder of mortgage -
DI"ail el. NO.. •( .
Address of assignee(number and street city state,and ZIP code)
Does applicant awn property in any If yes,what county? What Taxing District? Card CI 11x0• / rction
other county �j
other county ❑Yes ❑No 1 curient ye... (,�
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract Motu.__ ' se 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 w.._
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 aforementioned property on date application is filed-
Sig re( fu8 name) Date(month,day,year)°wn 1. �
liaq MI r 71U' ent address II//�oltfff applicant(number and street,city,1 state,and LP code)
"--7 authorized lLI f b• tl f R� of �1A7 lb€*or\ ' I\l �� &L\O 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. I - - _