HomeMy WebLinkAboutMortgage_Allen (20) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
, .,` illy
. - � FOR DEDUCTION FROM ASSESSED VALUATION
,.,C. State Form 43709(R13 m 10-15)
o I.
Pru'sarbed by Department of Local Government Finance 91f.,J-
INSTRUCTIONS:
- File Mark
To be filed in person or by mail. MAY 1 7 Mimed with:
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 S County Auditor
located on or before January 5 of the immediately succeeding calendar year. r - :U County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the •,..1: it rrl:r
where the properly is located during the tweHe(12)months before March 31 of each yearthe dehatagiq 410(INTY AU ul tU K
See reverse side for additional instructions and qualifications.
Applicant(owner q(res 'coons on reverse side)-see
Ta79Districc. Key number/legal description Record number Page number
/late--el' , A6-` z _ /3- /03 . 00/. / AA - oa6 l ? 1s3o
Assessed value of real property as of I Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment data,current year assessment date,current year date of application legal
Q ll or equitable owner?
98, 000 El Yes 0 No
If no,what is his/her exact sham 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
N/X 1 eal Property ❑ Annually Assessed
` Mobile Home(IC 6-1.1-7)
—
Name of mortgagee or contract seller —
Address of mortgagee or contract seller(number and street city,state,and LP code) n M,rat a /t c
Name of assignee or other owner or holder of mortgage
���/// 1 ` L L-� /'/iC, f-1 LEt
Address of assigns,(number and street dry,state,and ZIP code)
rnt coat e- /2- /5.30 Does applicant own property in any It yes,what noun What Taxing District? Has d
in Indiana? ❑Yes ❑No Current year! LJ Yes U 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
recorders office(including airy 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 coned and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
\ 'Signabrrycrameryhranarnel / Date(month,day,year)
Xl ua residenT ad///dressy off applicant(number and street,city.state,and ZIP code)
Gas o1,Ve sr nr'r:-kn 1,11 WIC, 70
Person authorized by duty executed of Attorney or by IC 6-1.1-12.0. Date(month,day,year)
•
Address of authorized person (number and street dry,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. .