HomeMy WebLinkAboutMortgage_Alden facer STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION �I,State Form 43709(R13/10-15) F
Prescribed by Department of Local Government Finance
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INSTRUCTIONS: APR 5 2 2011 File Mark
To be filed in person or by mail. Form filed with:
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
it- - the• v- • Bounty Auditor
located on or before January 5 of the immediately succeeding calendar year. (, 'Stir 1_•
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with th r ,(.; ❑ County Recorder
where the property is located during the twelve(12)months before March 31 ofeane i 'F '' i rOFi
See reverse side for additional liinnstrucuc instructions and qualifications. /�/1 e
Applicant nee baq xr/ 4, /ix_g.0.n.{side)
.i -ilX.i�l
Tap'pistrid /�f Key number l legal cation Record number Pa a number
ilob• %,� d (o- a-o „Roo 0041 /-y0 Oc 7 alp/5 FIDE
Assessed value of real as of Mortgage 1 Contract indebtedness unpaid as of Mortgage/Contrail indebtedness unpaid as of Is the applicant the sole
assessment date,current year ,e.acsment date,anent year date of application legal or equitable owner?
❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with h whom
tf name on record is different than that of applicant indicate beloww. Is the property in question:Annually Assessed
Alyea)Property ❑ AnnualyAssessed
• /"' Mobile Home(IC 6-11-7)
Name ggag°n tract sel WQ _______._ _..__
Address of mortga or seller(number and street,city,state,and ZIP code) - _ __- ___.=Z...
Name of assignee or other owner or holder of mortgage /S — 44T J d
Drawer NO
Address of assignee(number and sheet,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? rr. Card NO. coon
other ❑Yes ❑No , ' /L-27 - �b - /9 ,,f-o/.S
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract aidebteaness mar rs r man up.in,...;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 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 filed.
SJ
gnature{owners fun name) Date(month, year)
resident address of appfxant(number and -illy,state,and ZIP code)
5c erson ZZell, I- /CO AI ?r;,.ce i&r , -1-F3 =/-76/0
authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 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. .