HomeMy WebLinkAboutMortgage_Poston STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Townshi Year
• `i' FOR DEDUCTION FROM ASSESSED VALUATION y{�
/ Sate Form 43709(R13/10.15) ��� 11 ll
Prescribed by Department of Local Government Finance 1 aa�
INSTRUCTIONS: JUL
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 sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the prope Y Auditor •
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property.Must Me with the County AudifoGi ,pnII3OU NIY AUD IT RRecofder
where the property is located during the twelve(12)months before Made 31 of each year the deduction is sought
See reverse side additional instructions and qualifications. •
Applicant(owner oz;i-seer st as on mite sitle). - . 9- P CQit
Taxing District ��, r(L I t(Yy�,,W_.'LJ/[1.Q� j1J (1X,w/,,h_1 Remo Page number
- l ° t - 10 - on • 53a-mac. �3I S
Assessed value Bred property as of Mortgage/Contract indebtedness unpaid as of - Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
assessment date.current year e..e sivd date,anent year
data f��¢' legal or equitable owner?
If no,what is his t her exact share of interest? If owned with ICI V �q ❑ Yes ❑ No
spouse,indicate with whom
If name on record is different flan that of applicant,indicate below Is the properly in question:Mnuapy Assessed
❑ Real Property ❑ Annua9yAssessed t.1-7)
Name of mortgage or contract seller /� 2 J
Mobile lime
Address of mortgagee or contract seller(number and sheet state,and ZIP code)
Name of assignee or other owner or holder of mortgage '
Address of assignee(mutter and sheet eV,alt
Does applicant own property in any If yes.wh _ lien been requested tf yes,state amount of deduction
other county in Imams/ ❑Yes ❑No �� r ❑Yes ❑No
A recorder's is not entr7led to this office mdudtrg any deduction
ome swat 1 -3155 .))that contract the basis indebtedness the that is recorded in the county
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Deduction approved in the amount at
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20 20 20 20 20 20 20
Signature of CotntyArtdra County Date(north,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
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day,year)
Full residgaddress�ap (aunt
'�,L+L.WI/SlLLJ Zr e)
1'
Person a exceeded Potvery.Ayrrnep�IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street ory,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. . _