HomeMy WebLinkAboutMortgage_Brown STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
!�' FOR DEDUCTION FROM ASSESSED VALUATION
Stara Form 43709(R13/10.15)
Prescn'bed by Department of Local Government Finance
INS7RUC77ONS: JUN 0 8 2011
File Mark
W)be filed in person or by ntatl. Form fled 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 ' :proper. ' .i my Auditor .
located on or before January 5 of the immediately succeeding calendar year. . , -�I'h1Nhr
2) M o l e/M a n u f a c t u r e d Homes not assessed as R e a l P r o p e r t y.M u s t f i l e win t h e • gts.- U DI— Coves Recorder
where the properly is located during the twelve(12)months before March 31 of each `-M a'dedu 'vi Ls.sought
See reverse side for additional instructions and qualifications. al
Applicant(m°,contract buyer-sea restd ms an reverse side) - . 04:02 -
T ' "'" Key n desaiption , Record number Page number
Ian is -o ao / Eo35 6 c? 7 /7 /Qaa
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of - Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
c3sesauestt dais,aslant year assessment date,anent year data of application legal or equitable owner?
/ 9L550d ❑ Yes p No
if no,what is his I her exact share of interest? If owned wild someone other than spouse,indicate with whom
tf name on rend is ddferent than that of applicant,indicate below: Is the property in question:Annually Assessed
Real Property ❑ Annually Assessed
/�� /�tr�ffi�� `/� ,n-,., /I Mobile Home()C 6-1.1-7)
Nairn of rrmrtgagae � /`�. — .
Address of Iuuibs.yee or rota'seller(number and street,city,state,and ZIP code)
Nacre of assignee or Wrerowner or holder of mortgage _ —
Address of assignee(number and steel,ay,state,and ZIP code) - PS e 1- -t
Does applicant own property in any If yes,what county? • What Taxing District? Has U1 i /r �'Y�~�� m .
to
in
other county Indiana? ❑Yes
A person not entitled toils deduction unless the person has a balance on the person's morf �4 i L it G~ d A FJ 7 ity
recorder's office(including any home equrly fine of credit that is recorded in the county recordei /7_ /7 d Qt
COUNTY AUDITOR -
Deduction approved in the amount of
20 20 20 20 20 20 20
Signahnte of County Auditor - County Date(month,day,year)
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the appficant is a resident of Indiana and
owner I contract buyer of the aforem roperty on date application is filed.
�(owners bur name) Date(month,day,year)
( if 6 -O -/ 7
address of pfirant( street,city,state, ZI
>c a5-7 e4 `2nnewns4 � / / �„ Ai 7z.,-74
Person authorized by duly executed Power of Niamey or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and s feet.aTy,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.