HomeMy WebLinkAboutMortgage_Parker (15) Cry STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION ��y�
-'^ State Form 43709(R13/10-15) gA--11
�- Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
Fr
To be filed in person or by mail. AP o =• •p!:
Filing Dates 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought
Must be Med or postmarked with the County Auditor or County Recorder of the county where the property is 14 •u ., Au •r
located on or before January 5 of the immediately succeeding calendar year. , will tr..;.. Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of thepgl Nf� t •r_t
where the properly is located during the twelve(12)months before March 31 of each year the deduction
�L' C• • - • • -
See reverse side for additional instructions and qualifications.
Applicant(own or con by�t buyer-see restrictions on reverse side)
A �C1 eel • 4� •
_teasing Record number number
,ait �>1 aln l b - LI b� - bat.. l I *-t ce Page l
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,current year assessment date,current year date of application legal or equitable owner?
CP b `D Oa Li7es ❑ No
If ra what is his/her exact share of interest? If wined with someone other than spouse,indicate with whom 1
If name on record is different than that of applicant indicate below. Is the property in question Annually Assessed
QS>eal Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Nue of mortgagee or contract seller
Address of mortgagee or contact setter(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any If yes,vi. —(5 a I /•••.. Ton been requ led If yes,state amount of deduction
other county �J J�JJ JJ
in Indiana? ❑Yes _ ,\O ❑Yes ;No
A person is not entitled to this deduction um vac;Cl onbact indebtedness that is recorded in the county
recorder's office(including any home equity U that is the basis for the deduction.
Deduction approved in the amount of Ca I O
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 I contract buyer of the aforementioned property on date application is fled.
Signature( ruD )//// ®/ ,, yr,, Date(month,day,year)
Till "10-if Lt,dl-CX/aq
resident address of fipnt(number an street city,state,a3 ZIP co(*)
a�sOm5umo1nzed by duly 4�a of Attorney or nr+C s-i.1-i W-n -1 - r1/ u76 70 Date tmonrn,day,road
Address of authorized person (number and street dry,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. .