HomeMy WebLinkAboutMortgage_Hood STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
^, _ FOR DEDUCTION FROM ASSESSED VALUATION
�' ' -;�� State Form 43706(R1216-14) r �
`'7 r-'' Prescribed by Department of Local Government Finance g�,,,1J
INSTRUCTIONS:
•To be filed In person or by mall. JUL Fir Foam j
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought Form filed with:
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property,
located on or before January 5 of the Immediately succeeding calendar year. 1, r e Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor •21'
where the property is located during the twelve(12)months before March 31 of each u��41hCOU T�AUDPTyOR corder
See reverse side for additional instructions and qualifications. year the deduction is sought
Applicant(owner or contract buyer-see rest ons on reverse side)
r 1---/e� 4, n„ •
Taxing. District I ey number/legal description I ,
oc l0 1 AGMS., at . 4r/ ii f. /r Re d number c-�i num� 3
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpa �of is the applrcantl the
March 1,current year March 1,current year
date of application/� legal or equitable owners
If no,what is his/her exact share of interest? l!/i /a�%- 0 �� ❑'Yes ❑ No
�
� If owned with someone other than spouse,indicate with whom
If name on record Is different than that of a II
pp Indicate below: h^ Is the property in question Anrualty As;essed
6 - 1 7-35_300— A { ,t• I bo�}$�al Property ❑ AnnualN Assessed
Name of mortga ee r contract elier V- Vl/ V(JIQC Mobie Nome(IC 6-1.1.7)
`�2 Wg y „�E NA in-6 LAC
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
7200 .5271C/171//t(t � 57I // JOc?/Al c'L /y VDZZ.1
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,end ZIP code)
Does applicant own property in any if yes,what county? g I Has this deduction been requested If yes,state amount of deduction'
other county h'7 Ivdhat Taxing District? II
In Indiana? ❑Yes o II on property for
A current yeah ❑Yes Mgr)
recorder's office(including any home equity line of credit that Is recorded In the cu person's recorder's ofice)that Istthe baste for the-dedt�om�d in the county
Deduction approved in the amount of: COUNTY AUDITOR
20_ 20 1 20__ I 20
20 I 20_ I 20
•
Signature of County Auditor
County I Date(month,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
own ntract buyer of,he afo'emem nti ed,property-on date application Is filed.
Sig re wner's full name) x>J -
in,(/i/ Date day/Jyear)•
F idetnnttaadddress-of applicant(number and street,city,state,and ZIP code) O 742/4
1077 W /Ooo S cYr�i71-7/9�q� $76/7_ i�3y
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 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$10,000.