HomeMy WebLinkAboutMortgage_Durbin (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
- StaW Form 43709(R13/10.15) gY
�` ±-:- Presrnbed by Department of Local Government Finance q
INSTRUCTIONS: 1�. FF
To be hied in person or by mall. JUL 1 ' tq y�ph
Fiing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought ❑ L U I/
Must be Red or postmarked with the County Auditor or County Recorder of the county wdhere 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 file with the -1'County Auditor -••rder
where the property is located during the twelve(12)months before March 31 of each the del f the rb I. ,. tiV!hlllar:
See reverse side for addtiwhal instructions and qualifications. u�lffi`� OUNTY AUDITOR
Appliican� see�e iC ns on re side) -
• at 64(.." `1 .5i? /o/- )O/ 3 .S ad*/ Reid 1 � a
• -,vet to of properly as of Mortgage I Contract indebtedness unpaid as of • Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
:- date,ueren year assessment date,omen year date of application legal or equitable owner?
NZ.#571D. ❑ yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than crimt,ca,indicate with whom
If name on nerd is(gffaent than that of applicant,indicate below Is property in question:Annual,Assessed
• Real Property El Amwapy Assessed
Nam of
mortgagee contest seller � Aldine Home(IC 61.1-7)
(( (z/iflrfiu )( /lto-x-O
Address of mortgagee or contact seller( rand street dry,state,and ZIP code)
Name of assignee or other owner or holder of mortgage ' .{\- - 1
Address of assignee(n u m b e r street,ally,state,acct ZIP D I cC bt In )/cxcco J
D applicant own property in any C yes,what crnmryn till✓✓✓ lf9 equested If yes,stare amount of deduction
other in bd'ara? UYes 0 N - / _" ��� ❑No
A person is not enticed to this deduction unless the pc indebtedness that is recorded in the county '
recorder's office(including any home equity fine of e at the basis for the deduction.
COUNTY AUDITOR -
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of CountyAvddor County Date(month,day,year)
I 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.
Signature(a name Date(month,day,year)
Fug resident address of applicant ppl�cca (number and et col):state,and ZIP code) j
66/ E. 4-,$) pe,%ov,/cet t— AUi tie.0 414-ttW/ 2 29763r�
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,da,year)
-
Address of authorized person (number and street,rdy.state,and ZIP code)
The penalties for perjury can include imprisonment up to hvo and a half years and a fine not to exceed$10,000.