HomeMy WebLinkAboutMortgage_Bolden STATEMENT OF MORTGAGE OR CONTRACT INDEBT Township Year
ket FOR DEDUCTION FROM ASSESSED VALUATION
,__.: State Form 43709(R13/10-15) J
Prescribed by Department of Local Government Finance
INSTRUCTIONS: MAY 1 1 2017 File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Properly Must be completed and dated in the calendar year for which the dedy on is sought __CO Must be filed or postmarked with the County Auditor or County Recorder of the co0h/Ltd1@ isI County Auditor
located on or before January 5 of the immediatety succeeding calendar ye 1�tY/we-�J41
2) Mobile/Manufactured Homes not assessed as Real Property:Must file w M rePlU 3r166lkirbaC;lR County Recorder
Where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional
instructions and qualifications.
Amt(owner� \7J0"C Cze.,,,LJ
Taing District Key
number/legal description Record number Page number
t ia-01-moo d Lo-i3 -/9-&O 2 -0001/43o7 O ct1S WO/ 7 /413/
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,anent year assessment date,current year date of application legal or equitable owner?
070 OCC ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If nave on record is different than that of applicant indicate belay. . Is the property in question:Annually Assessed
fyeal Property ❑ Annually Assessed
�" Mobile Houle(IC 0-1.1-7)
Name of m r» or contra�rac-_t seller
Address of mortgagee or=tat ener(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
� � I 1
Address of assignee(number and street city,state,and ZIP code) T( 0. `y e(S ``lk et/\- A O
. uey t�� F
Does applicant own property in any If yes,what county? What Taxing District? $ �^ C \ duction
in Inddiania? ❑Yes ❑No a0 U
A person is not entitled to this deduction unless the person has a balance on the perso LI- S_ �� n _ `� the county
recorder's ofioe(including any home equity line of credit that is recorded in the county.___ ��
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.
Signature(owner's tail name) �c`��/� Date(month,day,Yew
FulYresideidaddress oY ' t Muncher and street oily,state,and ZIP code)
x g0-7 54A51 F/,:tne/*set). rN =7/7/0 y
Person authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 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.