HomeMy WebLinkAboutMortgage_Heltsley (2) y. ho STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Township Year
'be FOR DEDUCTION FROM ASSESSED VALUATION __-
3? i State Form 43709(R12/6-14)
••� Prescribed by Department of Local Government Finance
INSTRUCTIONS: I� hark
To be filed in person or by mail- j r pled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. 1 •
Must be filed or postmarked with the County Auditor or County Recorder of the county where the Rr oily is • County Auditor
located on or before January 5 of the immediately succeeding calendar year. JU�J 3 p n 17 ❑'County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the courtly--
where the property is located during the twelve(12)months before March 31 of each year the dedpcGOn is sought.
See reverse side for additional instructions and qualifications. `J/� _
Ap ant(owner or contract buyer- restrictio s n rever std ) GI B
n a I` IL( its lCn/`'(�/-► SON COUNTYAUDIr
Taxin ViU Key number!legal dress Lion — Record number AUDITOR Page number.fvco -orb-lg-3G7 -�f 2-000• 3"f9 -6°9 a() l' aY,o0
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1.current r� March 1,current year date of app1Wtwy, �/f legal or equitable owner?
1 Q Il[!j3/ JVU [14kes ❑ No
If no.what is his/tier exact share of interest? If owned with someone other thin spouse,indicate with whom
If name on record is different than that of applicant indicate below: Is their�opery in question:Annually Assessed
Lt}'Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Namnof�origagee orcoryract sel r • . 1 � 1_
Address of mortgagee tour contract seller(number and street,city,sstaattevand'GZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and streer,city,state,and ZIP code)
Does applicant own property in any yes,what county? What Taxing District? Has this deduction been requested If yes,sate amount of deduction
on other county ❑Yes o current property ❑Yes ❑No
"Indiana?
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 equity line of credit 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 , I 20 20 20 �Q`2/70� @j�-) 20 20
Signature of C n A itor" County _.,OUv-°�'1 �� Date(montn,�Y.ye4r)T�
IIJ, 11�/l/ x� `u-tJ Fes- ♦ )V
I I We certify under the penalty of perjury that the above a' •r:i.' g information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Si nor ! cone/s MI norm ) '1 1 1 r Date(marjhy,year)
Ywj...1` t�`�1��11�'III DO/ •1�,3 ao11
Fun r id address of applicant(number and street,city,state,and ZIP / ice
I ■
S . Darno5a JN 9
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 street.city,sale.and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.