HomeMy WebLinkAboutMortgage_Anslinger STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
1- State Fan 43709(R13/1415)
Prescribed by Department of Local Government Finance F I L Fi ir1
INSTRUCTIONS: File a
To be filed in person or by mail JUL 3 ?Urn Bled 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 property is ❑ County Auditor .
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property Must fife with the County Auditor of tf71 Recorder
where the property is located during the Melee(12)months before March 31 of each year th an 6 r AUDITOR _
See reverse side for additional instructions and qualifications.
Mint contract r Q 4 buyer- „,.....„..,-)
T • bind Key number/legal" aipt�O Record number Page number
a&-fig- 35 -300 — co dc. 5BY- o-.ty ?Of 1 I77Y
value at real properly as of Mortgage/Contract indebtedness unpaid as of . Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date•currant year diibabutwatt date,anent year date of applicati(on,' legal or equitable owner?
If no,what is his/her exact share of interest? If owned with om
someone� Yes ❑ No
spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is epau ropay In question:Annually Assessed
Property ❑ AmrualNAssessed
Mobile Home(IC 6-1.1-7)
Barre of m rtgagee or.., , ,.
r —— _
Address of mortgagee or „..serer(noun.: and street,raly.state,:.,. r•code) t'1�
/ sk �v.S `\n ai. of Rthe% _
Name of assignee or other owner or holder of mortgage ' `0_tr S tA(Lever —i.
Va`leY 51 -,', �S —
�¢ of assignee(nubeand streakaTysmote and LPode) G,v\�C Y;,�
f "r' 5 w + PT sE 3 5- 3 -ii /-04—c- . -zh , n I ,a 6 ., a��1 1�11
Does applicant own property in any If yes,what comfy? What Taxing District?
Has this de
other county , property
in Indiana? Yes ❑No - current yearn .—, w__ ._ 4- C 1, —
A person is not entitled to this deduction unless the person has a balance on the person's ne tgage or contract indebtedness that is recom u
ec in m..,......,
recorder's office(including any home owl),fine of credit that Ls recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR • . . •
Deduction approved in the amount of:
20 20 20 20 20 20 20
signature of Courtly Author Camty Date(month,day,year) '
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 I contract buyer of the aforementioned property on date application is filed.
taa(owner's ha name) Date(month,day,year)
. ono AID, elca -ix lir- 3- 20 /7
resident yull WO tf2a$ es O a t-/i yt44s9dF IN C'X Y,
Person authorized by duly executed Power of At amey or by IC 61.142-0.7 Date(month,day,year)
Address of authorized person (number and street,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 310,000.