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Home My WebLink AboutMortgage_Hurt (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN �` ? �k Township Year r~�� FOR DEDUCTION FROM ASSESSED VALUATION State Fenn 43709(213/10-15) Y-�• 1'• Prescribed by Department of Local Government Finance INSTRUCTIONS: JUN 16 2017 File Mark To be fled in person or by mad Form fled with: Filing Dates. 1) Real Property:Must be completed and dated in the calendar year for which the deduction -Hight 4 .i Must be tied or postmarked with the County Auditor or County Recorder of the county a.,`); r-er a r'- County AudHo , located on or before January 5 of the immediately succeeding calendar year. '�'',,,,``nr�r1,a�.,C(`nn`{�HTY AUDITO 2) Mobile I Manufactured Homes not assessed as Real Property:Must tae with the G xwtmPor the county minty Recorder where the property is located during the twelve(12)months before March 31 of each year the deduction is sought See reverse side for additional instructions and qualifications. Applicant( r or contract buyer-see ream s on reverse side) - - Taxng Key number/legal description Rand number Page number /124n,c,2.611r a6,-ia - 06 /10 a a . 376 -oat' ao ) 7 . a.571 Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of - Mortgage I Contrail indebtedness unpaid as of Is the applicant the sole assessment date,cement year assessment date,current year data of application legal or equitable owner? 301100o ❑ Yes ❑ No If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom If name on record is different than that of app5cant,indicate below: Is the property in question:Annually Assessed id Property ❑ ArmuatiyAssessed Mobile Home QC 6-1.1-7) Nacre of roatitgee or contract wiles /� R.Si 4Q.mi curl 62 LeMAca- Address of mortgagee or contract seller(number and street city,state,and ZIP code) Name of assignee or other owner or holder of mortgage ' Address of assignee(number and street idyl state,and ZIP code) - - ' Does applicant own property in any If yes,what aunty? • What Taxing District? Ora}}.e r r Seduction iindiar ? ❑Yes ❑No 11'O'••�� A person is not entitled to this deduction unless the person has a balance on the pets n the county recorders off ice(including any home equity fine of audit that is recorded m the count Card \1 o•COUNTY AUDITOR .'t<?.S-` .I.. . Deduction approved in the amount at 20 20 20 20 20 20 20 Signabne of CountyArafda 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. name) , Data(marrth,day,year) Fug resident address of epplicant(number and aty state,and ZIP code) 5// 4 rti.�lorA/e/ brr;vto� �,)/c,Io�1/, 271 470 Person authorized by duly executed Power of Niamey or by IC&1.1-1 -0.7 Date( day,year) Address of authorized person (number and street city,state,and ZIP cede) The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Conn Township Year t FOR DEDUCTION FROM ASSESSED VALUATION i. State Form 43709(813110-15) Prescribed by Department of Local Government Finance LE INSTRUCTIONS: Fite Mark JUL 1 Tote filed in person or by ma. �5!.•i r•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 properly', ❑ mY Auditor , located on or before January 5 of the immediately succeeding calendar year. .i 2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor g r;:..4 ,y v%��j�� nb'Recorder where the property is kicated during the twelve(12)months before Mardi 31 of each year the deduction is -f,. • U • a • - See reverse side for additional hstructions and qualifications. T istdct Key number/legal de-satiptio^ Record number Page number ao/Assessed value of real property as of I Mortgage I Contract indebtedness unpaid as of • Mortgage i Contract indebtedness unpaid as of is the applicant the sole assessment dam,anent year dz.babbilwort date,amend year date of application owner?n legal or equiable owner? Jo tV1000 ❑ Yes ❑ No If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom If name on record is different than that of applicant,indicate below: d PIURT t Name of mortgagee o oo,tradsego / fJ LLcs�M nit. >, , Address of mortgagee or contrail seller( and city,s��) C / A I r R 1-one t Name of assignee or other owner or holder of mortgage ' �/ • 1 (��M/4�Juco 43 Address of assignee(number and street,r6y,state,and ZIP code) • Does applicant own pruyerty in any If yes,what county? - what Taxing District? n other ha�? ❑ dtan Yes ❑No - ///777 A person is not entitled to this deduction unless the person has a balance on the person's /' / — 577 ( mty ' recorder's office(indudntg any home equity fine of credit that is recorded to the county rep COUNTY AUDITOI Deduction approved in the amount of 20 20 20_ 20 20 I 20 I 20_ Signature of County Atitirldor County Data(month,day,year) ' I 1 We certify under the penalty of perjury that the above and "rig trdormatmn is true and coned and that the applicant is a resident of Indiana and owner/co I -• • -r of the aforeme ' d property d application is filed. "..a.0 -(•.. 'r'name) {' �'� p Date(month.dal:Year)••Full resi�ent a/�df �y t(number and sent dry�;, e,an32tP` ) . ?7/ 77 !.PA/9 !0'/r VP 14 edrivlr%ax/ -r t/ ,')(i, 70 Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year) Address of authorized person (number and sheet aly state,and ZIP code) The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.