HomeMy WebLinkAboutMortgage_Martin STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County shi Year
FOR DEDUCTION FROM ASSESSED VALUATIONItr1
rS State Form 43709(R13110-15) I�Yes®
Prescribed by Department of Local Government Finance
INSTRUCTIONS: 1'
To be filed in person or by mad. Form fled with:
Fling Dates: 1) Real Properly: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 property is 1 ••4 y r . -°•or :
located on or before January 5 of the immediatey succeeding calendar year. 8-07►' Recorder
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County Auditor of th N C o `TYAUD I. •
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
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See reverse side for additional instructions and qualifications.
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T•.�1iI••( Key I vJ�) Record r Page number 14710 out- /�-o -405t, Odo3. O.i�- go? g- I1' a(z3
Assessed value of fast properly as of Mortgage I Contract indebtedness unpaid as of • Mortgage I Cardrad indebtedness unpaid as of Is the applicant the
asscssrnent date,current year assessment date,anent year data of application/ �/y� (f/� legal or equable owner?
-- - -. - - - `Q7 0 r `) _ ❑ Yes D No
If no,what is his I her mad 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. Is property in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Nacre of mortgagee or contact seller
e
Address of mortgagee or antrad seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage ' m/7'lily ILL. m a,���-1��
Address of assignee(number and street,Gay,,state,and ZIP code) 633 -"'
Does applicant awn property in any If yes,what county? W — <. -If yes,state amrnun of deduction
other courdy in Indiana? ❑Yes No
A person is not entitled to this deduction unless the person has: Tess that is recorded in the county
recorder's office(mdudtng any home equity fine of credit that is for the deduction.
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COUNTY AUDITOR ' •
Deduction approved in the amount of
20 20 20 20 20 20 20
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Signature of CouadyAuddor County Date(month day,year)
I 1 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.
Signahae`r name L Data(month,day,year)
Full resident address of applicant(number and sheet,city,state,and ZIP e)
z2o9 r ll✓ Ave , ��w:u� , 1:n/ 4/7o.65
Person authorized by duty exeNted Power of Attorney or by IC 611.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sbeet 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.