HomeMy WebLinkAboutMortgage_Lamb " STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
4,; FOR DEDUCTION FROM ASSESSED VALUATION
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<3.i.:74......-.,7 State Form 43709(R12/6-14) A IL J
.'"e Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed In person or by mail AUG 2 21
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought .rm,Ile.,vnth.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the pro.- , is
located on or before January 5 of the immediately succeeding calendar year. ' ri ❑ County Auditor
•2) fwfobife/Manufactured Homes not assessed as Real Property:Must file with the County A pp((R ';,A`�'mll - County Recorder
where the property is located during the twelve(12)months before March 31 of each year th c't'Ons: 1s•,it Y ' •
See reverse side for additional instructions and qualifications.
App t(owner or contract buyer-see rest otions on reverse side)
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T. Ig Disj.rict K b r/legal desciption • /4/ R n r Page number/ 4L ^
Assecs.Pd value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole
March 1,currentyear March 1,current year data of application
legal or equitable owner?
If no,what is his/her exact share of Interest? l30 �O� QO 9- %s 1::1 No
II 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
626- l i-13- `102 o 00 . l a(0-flaly eat Property ❑ Annually Assessed
Nan• of mortgag a or ntract seller
Mobile Home QC 67.1-7)
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Address of mortgagee o obntract_seller(number and street,city,state,and ZIP code)
9200 -)/r'/5 yvi«c 7e0 Sit /4 /oir/rv,(t c /It* 5/0233
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,cif,state,and ZIP code)
Does applicant own property In an If yes,what county? What Taxing District? Has this deduction been requested I If yes,state amount of deduction'
other county on property for
in Indiana? ❑Yes No current year? ❑yes [` io ^________,
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 I 20-- 1 20 20 20
20
ISignature of County Auditor - I 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
owner/contract buyer of the aforementioned,property'on date application Is filed.
I Signs re(ownln e f (applicant me) n nil
L!—Lh p(y ,rvtVllb/ Date(month,day,ye ,
0 7M, oi7
Full 'eataddr (number and street,ci state,and ZIP code)
sa iv, W£sr 5 -. r4rn -Cy �✓ '76 Vi
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 310,000.