HomeMy WebLinkAboutMortgage_Byrns (10) #1: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
4\,- County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
..t.:-.:::-.1..11,' Slate Form 43709(R73 f 10-15) yW 'gg
�- Prescribed by Department of Local Government Finance 9 tt
-INSTRUCTIONS: SSS 33A—.�JJ File Mark
To be filed in person or by mail AA`( Q $ 2017
Form filed with:
Filing Dates 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sou l
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is i •unty Auditor
located on or before January 5 of the immediately succeeding calendar year. 41 • County Recorder•
2) Mobrle/Manufactured Homes not assessed as Real Property:Must file with the County Auditor•!', r•'ruCINI•
where the property is located during the twelve(12)months befom March 31 of each yearlhe.•.:;hi' : ."'PILAU I S -
See reverse side for additional instructions and qualifications.
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Taxing District Key member l legal ption Record number Page number
Z2 S coo 0Z0 / '7 / 859
Assessed 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 assessment date,current year date of application legal or equitable owner?
❑ Yes ❑ No
If no,what is his f her exact share of interest? If owned with someone other than spouse,indicate with whom
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if name on record is different than that of applicant,indicate helper. s..Zcipeuty in question:Annually Assessed
Property ❑ Annually Assessed
' Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
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Address of mortgagee or contract seller(number and sheet city,state,and ZIP code) -
-- _
Name of assignee or other owner or holder of mortgage
Drawer NO...t*b17- is-9
Address of assignee(number and sheet city:state,and ZIP code) •
•
Does applicant own property in any If yes,what county? at Taxing District? Card NO.
Wh ..................... leduction
other county
i Indiana? ❑Yes El QA M No wl to /��]t,�j_I�1/��
A person is not entitled to this deduction unless the person has a balance on the person s rr,v„y... ,._. __-._ - O r the 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 aeouuw,,.
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.
ST", • re(owners, e) Date(month,day,year)
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Flap end.Tdress of applicant(number and , t • .slate,and ZIP code)
_ _ - . • • _ ' . rill( T H7665
Person authorized by duly executed Power of Ahomey or by IC 6-1.1-12-0.7 Date(month,day,year)
•
Address of authorized person (number and sheet city,sate,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.