HomeMy WebLinkAboutMortgage_Saucerman .fl STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
tit FOR DEDUCTION FROM ASSESSED VALUATION
State Fain 43709(R13/10-15)
Presaibed by Department of Local Government Finance
Fl .g I I
INSTRUCTIONS: rte/ 1
M be filed in person or by mall. Fmrri f :
Filing Dates: 1) Real Properly:Must be completed and dated in the calendar year for which the deduction is sought.
Must be fled or postmarked with the County Auditor or County Recorder of the county where the pr�e�ii 2 01 7❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the Calmly Auditor of • county County Recorder
mere the property is located dining the twelve(12)months before March 31 of each year the ded - .
See reverse side for additional instructions and qualifications. �( 'l %'rf111r .
t �� CIDCON COUNTY AUDITOR.
Applicant restrictions on reverse side)
Tang Distri'ccttt�_ ) number/legal description Record number Page number
W l 4 41-14- I a 4 -O4 - ao - 300 - 000- 897 -o , 7 I . .3.31Lj
Assessed value of real as of Mortgage/Contract indebtedness unpaid as of - Mortgage I Contract indebtedness unpaid as of Is the app&rant the sole
assess d date,aarent yea assessment date,anent year date of application legal or equitable owner?
If no,Wh
, at is his I her exact share of interest? If owned with someone other thane ❑ Yes El No indicate with whom
If name on recant is different than that of applicant,indicate below,: Is the property In question:Annually Assessed
• ❑ Real Property ❑ Amway Assessed
./- �t Moble Home QC 6-1.1-7)
Name dmortgag®edxmtrad s°lg4 Nr�-CJ Age,,,
Address of mortgagee or contact seller(number and sheet,city,state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage .
Address of assignee(number and street,thy,state,and ZIP^- ' E /e rr(� • c^. '/�� —
Does�t own property in any If yes,what mtmlyr R E a ECJCA T SAu earn a) requested If yes,state amount of deduction
in Indiana? ❑Yes ❑No + `( I ❑No
A person is not enlded to this deduction unless the p j I — ' 1'-'1 indebtedness that is recorded in the county
recorder's office(including any home equity fine of a the basis for the deduction.
Deduction approved in the amount ob
20 20 20 20 20 20 20
Signature of County Atmla County Date(area day,)ear)
I/We certify under the penalty of perjury that the abov and foregoing information is true and correct and that the applicant is a resident of Indiana and
'V si `contract r of the afore grope on date appfrcation is fded.
Data(month,day,year)
Full resident address of anagoani(number and street city,state,and ZIP code) .
6 6 ?o 3 So N 2 1 t.... .--• 4 14, Y ,
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 stream,say,state,and ZIP code)
The penafles for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.