HomeMy WebLinkAboutMortgage_Curtice STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
G FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 p
Prescribed by Department of Local Government Finance- _ F I ',+
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INSTRUCTIONS:
To be filed in person or by marl tL •i.:,with
Fling Dates: 1) Real Property-Must be completed and dated in the calendar year for which the deduction is sought. JUL 1 7 III
Must be filed or postmarked with the CountyAuditor or County Recorder of the county where the properly is • County Auditor
located on or before January 5 of the immediately succeeding calendar year. •
2) Mobile I Manufachrred Homes not assessed as Real Property.Must file with the ra Recorder ifs where the property is boated during the Melee(12)months before March 31 of each year the rtaci mn Cars,U.' AUDITOR
See reverse side for additional instructions and qualifications. ti DSO •
AppficaM(ommer or mnuactbuyer,-' see restrictions on reve�et'�\ -
Taxing District Key number I legal desalt:Ifion Record number Page number
4, - /7 -o/ _ yo 3 -- o oO. 'V 4 - 61 2 ao t 7 3o3 3
Assessed value of mal property as of Mortgage I Contract indebtedness unpaid as of - Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment dale,current year abuu.0 oa.d dale current year dab of application legal or equitable owner?
(.Ott 000 ❑ Yes ❑ No
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If no,what is his l 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:Arnuafly Assessed
0 Real Property ❑ Annually Assessed
_
Mobile Home(IC 6-1.1-7)
Named mortgagee or contract seller ♦, C n /1 , -1y.
Address of mortgagee or contact seller(number and sheet, Csta+e-e,,7Marid ZIP code) �IIC'r r f �, C IAN' 1 \ L e —
Name of assignee or other owner or holder of mortgage ' 1 I �, \�
QaYII V V\-.'�eci. c\or-ki019
Address of assignee(camber and street city,state,and ZIP code) J
PT SE 1 -1 -1)- , 27A- (- . (ao (ooe, 9101'1-13)33
Does applicant own property in any If yes,what minty? . What Taxing Dishier? Has this the deouc ar.,�..-,_---
trhdia�? ❑Yes 0 N - 1 ? ❑Yes 0 N
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(tndudmg any home egwTy fine of credit that is recorded in the county recorders office)that is the basis for the deduction.
COUNTY AUDITOR - - -
Dedudion approved in the amount of
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20 20 20 20 20 20 20
Signah rte of CourayAUdlor County Date(moth,day,year) -
I I We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner I contract buyer of the�aforementioned_property on date application is filed.
6igrtaWretDw_rhels fW�i/rt2l..Z.il ei-,CA(.t.(�C (Dale(month,day:year)
resident address of applicant(number and street city,state,and ZIP code)
070SAI. NIa-Sr r/b)enruj[ tit -7if Y:3266-
Person 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,oily,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.