HomeMy WebLinkAboutMortgage_Stoner �;a., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
•;' '- State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: d
To be filed in person or by mail Form filed with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought MAY 2 3 ol;b
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property unty Auditor
boated on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the tour'
where the property is located during the twelve(12)months before Mann 31 of each year the deduction is r%"(•r 4-a'yyri;
See reverse side for additional instructions and qualifications.
Applcant(owner orcontract r resv+aionsonreverseside) _1') /� CIDSON COUNTY 4UnITnR
Taxing District -a V r 1 l//as---goow„_ MY�r o .4,1‘, - A D Retord�u Pa/ge1n0'r
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid asoFIs the applicant the sole •
assessment dabs,cement year ! nt yea date of application legal or equitable owner?
l 01(/JT(/J\(7/, ❑ Yes ❑ No
It no,what is his/her exact sham of interest? if owned with someone other than spouse,indicate with whom
it name on record is different than that of applicant indicate below. is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
• Mobile home(IC 6-1.1-7)
Name of mortgagee or attract seller /0 C
Address of mortgagee or contract seller(number and sheelt`�,city) state,and LP code)
Name of assignee or other owner or holder of mortgage~- _ _
Address of assignee(number and sheet,cub T r V r n d('{v n G x
Does applicant own property in any If yes ' ' /CD — '3-/S -, 7 deduction been requested If yes,state amount of deduction
other county ELY roc
in Indiana? ❑Yes ❑No 9 9 SSV, r" ear? ❑Yes ❑No
A person is not entitled to this deduction n lge or contract indebtedness that is recorded in the county
recorders office(including any home e Fee/on m r r n y c e v,'r,_'-„',n ;office)that is the basis for the deduction.
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County` - Date(month,day,year) •
I/VYe 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
r/contra buyer of the afar mentioned property on date application is filed.
SDate(month,tlay, ar)
r/zs,37
tlss of applicant(number/and city state,ands) P � S 4 76'
Person authoriz duty executed Power IC 6-1.1-12-0.7 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 810,000. - -