HomeMy WebLinkAboutMortgage_Fulton sa STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
(21t.i,),T: FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13110-15) FT
Prescribed by Department of Local Government Finance
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INSTRUCTIONS: I
To be filed in person or by mail. MAY 0 9 2 pri filed with:
Ring Oates I) 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 immediaffiN succeeding calendar year. as un Recorder
2) Mobile/Manufactured Homes not cal Property:Must file with the County Auditor of 1-„',q,lytpw; b
where the property is/or nths before March 31 of each year th>i,.i .yc � f^' V AUDITOR
See
- _ ` ,/j. Record n e number
• I . igetg ml — I r /?SO Assessed valued real property as d Mortgage/Contract indebtedness unpaid as of fOlstgaDab
ortgage/Contract indebtedness unpaid as of Is the appliant the sole
assessment date,canard year assessment date,current year te of apylption legal or equitable owner?
(/3 6 CO ❑ Yes ❑ No
If in what is his/her egad share of interest? If owned with someone other than crwvrce,indicate with whom
If name on record is different than that of applicant,indicate belay. - Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Named mortgagee or contract seller � '�
Address of mortgagee or contract seller(number and sheet fccde)
Named assignee or other owner or holder of mortgage
I O
Address of assignee(number and street,dfy,state,and ZIP a le I'l— k l SO
C? 1 1 P
Does county applicant own property in any If Yes,what county? LC-v Y'Y b • d. J CC9/11,C`\h Q meted If yes,state amount of deduction
other in Ind ❑Yes Duo V-L.-Vko V‘-• —k 6 Co ABC., 7No _
A recorder's ice(including y home deduction unless ec \ g 13 0 0 bt is&t the ed ctioNed in the county
0 )atis for the dedrx�an.
s1 - f1
Deduction approved in the amount of:
i
20 20 20_ 20 20 20 20
Signature of County Auditor County - Data(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 t contract buyer of the aforementio.ed roperty on date application is filed.
S A ( /� �� Date(month,day,Yew
Full reLr 0 address-of nt(number a • ,yr#e,arN ZIP e) LI 26 7 tl
Person auauthorized by duty executed Pow of Attorney or by IC 6-1.1-12-0.7 ((( ' Date(month,day,year)
Address of authorized person (number and street city,state,end ZIP code)
The penalties for perjury can include imprisonment up to h+o and a half years and a fine not to exceed 510,000.