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HomeMy WebLinkAboutMortgage_Hudnall STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year c " FOR DEDUCTION FROM ASSESSED VALUATION fa Stale Form 43709(R13!11-15) Prescribed by Department of Local Government Finance INSTRUCTIONS: File Mark To be filed in person or by mail. • filed with: Hiing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the ded ' is Must be filed orposbnarked with the CountyAudtor or County Recorder of the courtly Were Courtly Auditof , located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder 2) Mobile/Manufactured Homes not assessed as Real Properly.Must file valh the County Audr,' Icteegogr l where the property is located during the twelve(12)months before March 31 of each year the dedvtliurh}s stf[irt. See reverse side for additional instructions and qualificati ons. Applcant(owner o r t / )K 7 a p r side) . y • Kei numbeb0 y y r 14 NCOJA f Rp Taxing Distict Page number ©5-� —000. 1 9— /1 I—I2 o Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of " Mortgage/Contract indebtedness unpaid as of fs the appEnent the sole assessment date,oared year assessment data anent ar date of application legal or equitable owner? 314 gob 0 Yes ❑ No If no,what is Ids!her exact share of interest? If owned with someone other than son isa,indicate with whom If name on record's different two that of applicant,indicate below I Is the property in question:Annually Assessed �/y /� ProPertY !lrvluafly 1.1-7) Nave o<mMgagee or contract Seger `/`7' a AI1,i�, Mobile Home—• Address of mortgagee or contract setter(number and street city,state,and ZIP code) t� n U� Ni 1 p , , Name of assignee a other owner or holder of mortgage I ^/^"""'� Address of assignee(number and street al:stole,and ZIP code) • '� J�,,„( 1� Does applicant own pubeiry In any t yes,what comity? • What Taxing District? Has tits dews.,., CCV//111 i /C^X/ on on property for tnma ? ['Yes ❑No current year? ❑Yes ❑Nil A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtactness that is recorded in the county recorder's office(induding any home equity fine of credit that is recorded in the county recorders office)that is the basis fn the deduction. COUNTY AUDITOR " • ' Deduction approved in the amount at • • 20 20 20 20 20 20 20 Signature of CountyAuditor County Date(month,day,fear) I I We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and owner!contract buyer of the aforementioned property on date application is filed. ��(ownaY,Sji,�name) - `t Data(month,day.year) Full eat address of appliicanjJ t/(rt e`eracd street V e,and n ) 1600 to S 41.1276 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,city,slate,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.