HomeMy WebLinkAboutMortgage_Brothers ta STATEMENT OF MORTGAGE OR CONTRACT INDEBT ETA Township Year
•'`'- FOR DEDUCTION FROM ASSESSED VALUATION 1
'• State Fonn 43709(R13/10-15)
-- Prescribed by Department of Local Government Finance
2
INSTRUCTIONS:: MAY 1 'L 2.017 File Mark
•
R,be filed in person or by mail. .Form filed with:
Filing Oates 1) Real Property Must be completed and dated in the calendar year for which the ded ,.r• •is so 'ein4
Must be filed or postmarked with the County Auditor or County Recorder of the.• .-...rr ill t,':14_Ii; County Auditor
located on or before January 5 of the immediately succeeding calendar year. ��c�fr1�H COUN ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with t ebtmty Auditor of the county
whem the properly is located during the twelve(12)months before March 31 ofeach year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant( or coma buyer- --- - ., . reverse )
l " Zca 'J4l A evz
. / Key number I legal description �// Record number Page number
ZGea � , 0220-- r-6 7- M/ v Ay`9 Qa�, Roil /4.00
Assessed value of real property as of Mortgage l Contract'indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment udate,canard year date of application legal or equitah'e owner?
�'7�5O ID Yes 0 N
If no,what is his I 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`thee petty in question:Annually Assessed
dal Property ❑ AnnuallyAssessed
• / Mobile Home(IC 6-11-7)
p4of mortgageeAccAtract seller
A`Jdress of mortgagee or a»seller(number and street dry,state,and ZIP code)
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Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code) -
o applicant own property in any If yes,what county? what Tax (C��`` �����l r`� J ;state amount of deduction
in Indiana? ❑Yes 0 N MqV V C \�
A person is not entitled to this deduction unless the person has a bans \ - O s U.,t FEvt rat is recorded in the county
recorder's office(including any home equity line of credit that is retort L0�)ti S T\ ,deduction.
V\t"_ h Ci{ 1aJO.00
Deduction approved in the amount ot. C1 - I(o Op
20 20 20 20 20 I 21) —1 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 coned and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Sig p nom /) Date(month,day,year)
r� (/rte]//1/�/��(//�{,f-[,�(//
Full s al cant(number and street dry,state,and ZIP code) _-
/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 et city,state.and ZIP code)
co a 7 Yi 1 ,s(1_,) 7t�S f /0e,/S&,22 .e 2-4/ g74
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. •