HomeMy WebLinkAboutMortgage_Walker (2) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
AOC" FOR DEDUCTION FROM ASSESSED VALUATION
•. State Form 43709(R13/10-15)
Presaibed by Department of Local Government Finance
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INSTRUCTIONS: IA!ggFile Mark
lb be filed in person or by mail. 11 Fo
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 property is yi ditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CountyAuMor of the court P.
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
ch 20'7
See reverse side for additional instructions and qualifications.
Applicant( con see�ievers�snjgl
�I�Kr��,,,, rcli 'L] Q n/trftb1/'� /1 pY� GIBBON M/SO'°eidtC u,-
Ta>ong District ! /l J lJl/CJ• �Va(1 Record w• r r• evgar(�IDer 3
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the soTE -
assessment date,current year assessment date,current year date of application legal or equitable owner?
4100.00 ❑ Yes ❑ No
If ro,what is his I her exact share of interest? If awned with someone other than spouse,intricate with whom
If name on record is different than that of applicant indicate setoff. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Hone(IC 6-1.1-7)
Name of mortgagee contract se H— f I J 2 /1
Address of mortgagee or contract seller(number and s6�e;taty state,and LP ) L(-J(/`•(�,(q%J�J
Name of assignee or other owner or holder of n ���111 —
Address of assignee(number and street city,s .
Drawer 1NO...... ,
'''
Does applicant own property in any -If yes,v " lotion been requested If yes,state amount of deduction
other county er
in Indiana? ❑Yes ❑No f13 ' ❑Yes ❑No _
A person is not entitled to this deduction t Card d 1N O• •••...,.��,(��,, \ or contract indebtedness that is recorded in the county
recorder's office(including any home eqr. cc�� ice)that is the basis for the deduction.
COUNTY Autn i Lin
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.
ngnature(/1,1
/ Date((month,day,yea')
- !//2/Za/-0r t
and street dry.state,and code) \1/K ti 26 7 U
P,, authonzed by duly executed Power of Attorney IC 6-1.1-12-0.7 \, Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) N.
The penalties for perjury can include imprisonment up to two and a hat years and a fine not to exceed$10,000. _ .
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