HomeMy WebLinkAboutMortgage_Phillip , .): STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION .
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�'- Stete Form 43709(813110-15) gg gggg ����''''1111
Prescribed by Department of Local Government Finance.
inance ICE
INSTRUCTIONS: File Mark
To be bled in person or by mai fled with
Filing Dates: 1) Real Properly.Must be completed and dated in the calendar year for which the deduction 4ht. 2017
Must be filed or posbnarked with the CountyAuditor or County Recorder of the county wtw$i The property is minty Afklitof
boated on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County •-r.fiord a- e.:.,..' ❑ County Recorder
where the properly is boated during the twelve(12)months before March 31 of each -- i0: !,..•447 !'. - .
See reverse side for addtionalinstructions and qualifications. //�� GlgSC1N COUNTY AUDITOR .
'P7°{( co Wact° 7Ceiw s on verse side) z. 9 /�� p
r n /bict 7l ICJ r .Q,m �' /�'Q[i v /Z) s'
T Key number/legal desertion
( a �a=o7 0704i /..3i5 oak a 7
Assessed value of red property as of Mortgage/Contract indebtedness unpaid as of • Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date current year asassrnent anent year^^� data of application legal or equitable owneR
I`�7 /D C.� ❑ Yes ❑ No
if no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is ddfferent than that of eppSrant,indicate below: I Is the property in question:Annuatty Assessed
❑ Real Property ❑ An uafly Assessed
I Mobile Home(QC o-1.1-7)
Name of mortgagee contract setter ca v k—t ` at p1
Address of mortgagee and *ee4b M o\n v,Qevy L,\Ct Vo�Ici V 4....,U•,tips
Name of assignee or other owner or holder of mortgage ' b O N.Q Q--
V_ .
Address of assignee(number and street,ally,state,and ZIP `�`I t
lb •OQ
Does applicant own property in any If yes,what county? - What Taxing District? Has this deduction been requested If yes,state amount of deduction
other in dian�a? ❑Yes ❑No - current ? ❑Yes ❑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 recorded in the county
recorder's office(including any home equity fine of area 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 20 20 20 20 20 20
•
Signature of County Auditor County Data(north,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/contract buyer of th aforementioned property on date application is filed.
5grahne • tun � } Date(month,day Year)
x/77/7
FW .... nt(number and street,city,state,and ZIP code)
authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,a11: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.