HomeMy WebLinkAboutMortgage_Riedford STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Catnt g wnship Year
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A.:``�,' {;- FOR DEDUCTION FROM ASSESSED VALUATION F j �� State Form 43709 by (R13I ment 10-15)
of Local Government "
". ', Pre.,cribed Depart Finance
INSTRUCTIONS: JUIV"Ii '-r
To be filed in person or by marl. Form iN wit :
Filing Dates: 1) Real Property:Must be completed and dated hi the calendar year for which the deduction is sought.
Must be filed orposinarked with the CountyAUdMor or County Recorder of the county where the pmpe ,.. • !M :• t • •itor
located on or before January 5 of the immediately succeeding calendar year. i�npc. u 're l t .. my Recorder
2) Mobile/Manufachaed Homes not assessed as Real Property:Must ffie with the County Auditor o91b1HWMtfrOU TY . .
where the property is located during the twelve(12)months before Mandy 31 of each year the deduction is sought
See reverse std; additional instructions a ualifications.
Apprl:ant(• i' or ccera,buyer- re )
T. ;slot,/ Key /legal Record r Page number
ix) c -d3 i3 -/c-O- o0/. ,34-2-0-07 , - Q��(] -7+8p014
.•value of real property as of Mortgage/Contract urdebtedness unpaid as of " Mortgage/Contract indebtedness unpaid as of Is the app6cardd the sole
" :.,dais,parent year assessment date,anent year date of application legal or equitable owner?
/AO ado ❑ Yes ❑ NO
ff no,what is his/her exact share of interest? If owned weir someone other than spouse,indicate with whom
If name on record is different than that of applicant,ird'icate belay. Is property in question:Annually Assessed
• Real Property 0 M apy Assessed
Mobile home(IC 6-1.1-7)
Name of mortgagee or contract s Uer /�,/fly^ /)a (2a `71��7 Address of mortgagee or contract seller(numberamd street, itnd ZIP code) ,1(f^/",���
Name of assignee or other owner or holder of Incept
Rvakd C/� /O L/�Address of assirycee(number and Steet afy,state,{ `�r1//11
Does applicant own property in any If yes.what co ' 1 a been requested If yes,state amount of deduction
o0cer ❑No -��('y CI Yes ❑No _
'offMiaannary? El Yes ���"'"`-1
A person is not entitled to this deduction uNess ontract indebtedness that is recorded in the county
recorder's office(mdudmg any home egtrr'y fine_. _--_._- that is the basis for the deduction.
COUNTY AUDITOR " -
Dedumon approved in the amount of.
20_ 20_ 20 20 20 20 ( 20 .
Signature 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 applicant is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
S11','',� ) Date(month,day,year)
-E. RA residentadd o nu: ; is�ZIP code) •
ThH15ZE 12f0S 1101 -l4lk, �Y1�
Person authorized by duly Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,cry,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.