HomeMy WebLinkAboutMortgage_Dove STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ri.. ru `J iw^ Year
FOR DEDUCTION FROM ASSESSED VALUATION
I
:'s. 'f' State Fain 43709(R13/10-15) - �
Prescnbed by Department of Local Government Finance .
JUL 2 4FiciWarjc
INSTRUCTIONS:
To be filed in person or by mad. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sough
Must be filed or postmarked with the CourdyAuddor or County Recorder of the county whew g1e —Cody Auditor ;
located on or before January 5 of the immediately succeeding calendar year. G IBSp ur
ON COUNTY A
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County Auditor of the county .
� Recorder
where the properly is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
(owner orconbaabuyr-see [/ son reverie side) •
Key number/legal description Record number Page number
a - - a4, -/3 - 0? 5 - /Do - 000. 94(8-oo6 t -7 3o S g
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,aarent year assess end date,aarent year date of appl�bon ,. legal or equitable owner?q/ I0 .5 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other Kan spouse,indicate with whom
If name on record is different than that of applicant,indicate below. property in question:Annually Assessed
,Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract siegr is, C
Address of mortgages or contact seller(number and street,my,state,and ZIP code) l' Ue J1:Th/11 n-ri—
tA
Name of assignee or other owner or holder of mortgage ' PNf
er
Address o assignee(number and street ary.sate,and ZIP code) /1 30 �e
D��t own property In any If yes,what county? What Taxing District? �� _ VVV cot of deduction
in Indiana? ❑Yes ❑No - I current year? ❑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 egwly fine 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 at
20 20 20 20 20 20 20
Signature of County Auditor County Date(nmdlt 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 aforem> i• -• property on date application is filed.
Si9nataa(owT+j' "., :) , / /J Date(month,tai:year) /)
/.. �o(appG TTI"u� streets,c ,state,and ZIP code) �/ZB�
a 7 3- 6, A 5 ' 57 D ---.1- CZ, it;.1-- -Li 4. 4 o
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 cif%state,and ZIP code) �I iiirrr
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. ' � � c n