HomeMy WebLinkAboutMortgage_Creek (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
'"� Township Year
--�'' State Form 43709(R13/10.15)
Prescribed by Department of Local Government Finance —FILED—
INSTRUCTIONS:
To be filed in person or by mail. Fonn feed with:
Filing Dates: 1) Real properly.Must be completed and dated in the calendar year for which the deduction is sought JUN 1 9 n L.1
Must be filed orposbnarked with the County Auditor or County Recorder of the county where the properly is County Auditor
located on or before January 5 of the immediately succeeding calendar year. A .. My Recorder
2) Mobile/Manufactured Homes not assessed as Real property.Must tile with the rn.mty Auditor of.
where the property is located during the twelve(12)months before March 31 of each year the y:.r 4,-Su-Su z •-• _
See reverse for additional instructions and qualifira/tior7n�ss •7 • JNTYAUDITOR '
Applicant Ac,D tp r ." • Q. (/ / /X/x-
2 /,�/j//1 akinniasoirni
/ �/ number�f jam_
Tazmg :.— e /�Irl% / "D- a 6.55/.3- a / aid ( . SST ,
of :: Mortgage/Contract indebtedness unpaid as of . Mortgage t Contrail indebtedness unpaid as of Is the applicant the sole
-. •
assessment date,current year data of app/r adan/ n boat a equdase owner?
f9 _z ❑ Yes ❑ No
If no,what is his I her exact sharb of interest? If owned with someone other than ,indicate with whom •
If name on record's ddfa,ad than that of appGpnt,indicate below-. ts property in question:Annually Assessed
gj Real Property ❑ M Assessed
Mobile bte H Home(tC 6-1.1-7)
Ranh of mortgagee or contract safer
hil 72)24-
•
Address of mortgagee or contract seller(number and street,rely,state,and ZIP code)
Name of assignee or other owner or holder of mortgage /'1 ///� .
Address of assignee(number and street,dy;state, JP rode) it o ���Z 3—/ 4 /_ cc
Does applicant own property in any If yes,what What Taxing District? Has this deduction been requested If yes,state mount of deduction
other inlndian�a? ❑Yes Ohio CCC/// current year? ❑Yes 0 N
- 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
recorder's office(including any home equrly fine of Greiff 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 \ l..ree--V--- 20 p.
Signature d CaadyArefdrx Corr —�v V`5`
ao �� spa go:\:o�es\ .
I/We certify under the penalty of perjury that the above and foregoing informatior \�` v'v..v..�— Indiana and
owner/contract buyer of the aforementioned property on date application is filed. , b0 V ' 3 C
4 S g ore Owner's name) 0 Z 1
Fug dasid// enerdrlaadddress f apPGmd(number m1berer aandd street,city,state,and ZIP code)
ei34g 5 G )0Sr) L.1 ). 0 tuirk v°f)9 1--k) 4 7F S
Person authorized by duly exeaded Power of Attorney or by IC 621.1-12-0.7 / 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$10,000.