HomeMy WebLinkAboutMortgage_Pullins ,> STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS minty Township Year
cr' FOR DEDUCTION FROM ASSESSED VALUATION
' State Form 43709(R13I 1x15) . . -
Prescribed by Department of Local Government Finance
INSTRUCTIONS: Fi r,
To be hied in person or bymatl �t ,.:: : ,
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought _ - !• .
Must be filer!or postmarked with the CountyAuddor or County Recorder of the county where the property is joy ❑ , ;>
2) Mobile//Manulachaed Homes nottassessed as Real succeeding t calendar year. �t g Recorder
Property.Must file win the County Auditor of the county ,° c U/ .
whem the pmpery is located during the twelve(12)months before March 31 of each year the deduction isso�1r7�[
See reverse additional instructions nd gsualifications. Gft c• �
Aavr�rr( or / �aj� L(J L/Y O oNC�UNTy
T �f // Seri Rend were i/Prajoh gazer
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Assessed value cheat paper!)+as of Mortgage i Contract indebtedness unpaid as of . Mortgage i Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assess nent date,anent year • data of application `/! legal or wettable owner?
Ito,what is his I her exact shad of interest? If owned with someone other/ s�O ❑ Yes ❑ No
spouse,indicate with whom
If name on record is dffaren%than that of applicant,indicate below: s property in question:Annually Assessed
• Real Property ❑ ArtnuaiyAssessed
TTTTTT11\ Mobile Home(IC 6-1.1-7)
Marto ofiartgag®asofter \ /S n
Address of mortgagee or contact seller(number and!/sheet thy,state, ZIP code)
Name of assignee or other owner or holder of mortgage � FOK o AL C /t) 7—09 — Q/ / /� /�
Address of assignee(neater and street thy,sate,and ZIP code
•
Does applicant can property in any If yes,what county? - What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county
? ❑Yes 0 No anent year? ❑Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is mavvins in H.,,county
recorder's office(alluding any home manly fine of audit that is recorded in the county rec—COUNTY AUDITOR 44..Q1 Pte\\\V. S
•
Deduction approved in the amount of A-O S-(j cr\- C O.
20 20 20 20 a.0�� - a Li `R
id-au- n —
Signature of County Auditor County JG 1 1 t --30• 0°
I I We certify under the penalty of perjury that the above and foregoing information is true dl ro wires am mat the applicant is a resident of Indiana and
owner I contract buyer of the mentioned property on date application is filed.
Signatu a(�- Date(month,day,year)
6(?�(2�7 X FSI/ T ad (number doe,stateAnd ZIP code)
,' 5r S < rvrr G�73 7 , Zric,i-y Geer r / - t2r o
--. authorized by duly executed PowerofAttomey or by IC 61.1-12-a7 Date(month,day,year)
Address of authorized person (number and sheet rdy 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. - - --