HomeMy WebLinkAboutMortgage_Brothers ��E 4a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
Cc rr_ : FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13110-15) F
;•. Prescribed by Department of Local Government Finance 1!•-( p p
INSTRUCTIONS: tlllii
To be filed in person or by mail. APR 2 I ZO f'/d wnR
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 ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year - -ecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the c:2, •7dii
where the property is located during the twewe(12)months before March 31 of each year,the ded tI i M r to 11
See reverse side for additional instructions and qualifications. UNTY AUDITOR
Applica t(owner or contract buyer-see restrictions on reverse side)
cAam b fro- hers
Taxing District Key number/legal description Record number Page num r
4 -- la-o7- 40 ► -00a, sy7 - oz II aoll - ,
Accessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessmeot-date.current year date of application legal or equitable owner?la
SU a 00 19 r, 8 c- er Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
[4eal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller II
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Address of mortgagee or cons ct seller(number and street city,state,and ZIPcode)
Mk I 7)4ec-ler 0i. E l/a/lst,iilr zit(/ V7715—
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,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction •
other county ,—, - on property for r-,,,in Indiana? ❑Yes (I No current year? WJ Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the 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/contract buyer of the aforementioned property on date application is filed.
Signature(ow•ers full name) a Ste(month,day.year)
. .aid rir a o3/0.7'I/cRCJ7
Full resident address of applicant(number and street,city,stale,and ZIP code)
sa7 F Gott er St ; Pr :, (-c-J-vnr TT) Li762o
Person authorized by duly 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.