HomeMy WebLinkAboutMortgage_Lefler e .^�` STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
/4�- , FOR DEDUCTION FROM ASSESSED VALUATION g•sl State Form 43709(R12/6-14) F I L D
S � Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail.
JUL, '] 2017 Form filed rith:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which me a uc con 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 yea ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file wi .r.r ' .,Pii P or of the county
where the property is located during the twelve(12)months before/twgrgb of :0 :qr 1 d %' s sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Pal d f.e , -e( J-Sarah Leer 1 N/■
n Dist d Key number/legal description Record number Page number
QAA D(0 — (1 -31-3o3—ooq , 3SS- 0a► a0CI1 'v2(i
Assessed valu f real props s of Mortgage/Contract indebtedness unpaid as of Mongage/Contract indebtedness unpaid as of Is the applicant the le
March 1,curre. year March 1,current year date of application legal or equitable owner?
113 coo . 00 g--Yes El 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 different than that of applicant,indicate below- Is the property in question:Annually Assessed
[..}'Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Mo vemcn-1- M or-I-uo o r LLC
Address of mortgagee or contract seller(numbeJar treed city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
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 county on property for
in Indiana? Yes No current year? ❑
CI �
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 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 _ 20 20 20 20 —
20 20
Signature of Cou �Idit r / County Date(month,day,year)
I I •e certify under the penalty of perjury that the abo i ••..r-..ing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned pr n da - application is filed.
Si attire(owner's full name) Date(month,day,year)CIAS
Full resident address EYpplicanl(n m 17aNAtreet,city, tete,an ZIP code)
4 a9 q S. S-f-a - 4 S(( Ocuensvi H. IN (0(0[o S
Person authorized by duly executed Power of Attorney or by C 6-1.1-12-0.7 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 510,000.