HomeMy WebLinkAboutMortgage_Highley STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS D hip Year
FOR DEDUCTION FROM ASSESSED VALUATION
.1- State Form 43709(8131 10-15)
Presaibed by Department of Local Government Finance
INSTRUCTIONS: AUG 7 Z Mark
To be filed in person or by mall. Form filed with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar y r for which the deduction is so t.
Must be filed or postmarked with the County AUdtor or County Recorder of the county where e County Auditor ,
located on or before January 5 of the immediately succeeding calendar year. Not f(��I
2) Motu7e I Manufactured Homes not assessed as Real Properly.Must Me warn the Co bYtkckdIIW AU?1`f0 F my Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is sough.
See reverse side for additional instruction and qualifications.
Apprram/X11(,o�w�neerr or conttaactbtt er-see restrictions on reverse side) - •
T),"t£nsma� O _ number/ Read number Page number
/-a10 s-. < - a l p..0 'I- - ,o, coD . 3/V _O •-a I 1 3308
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of - Mortgage/Carted indebtedness unpaid as of is the applicant the sole
assessment date,anent year assessment date,current year date of appfaabon legal or equitable owner?
9V, 9Vq ❑ yes 0 N
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on read is different than that of applicant,indicate below: Is the property In question:Annually Assessed
❑ Real Property ❑ Annually Assessed
/� Mobile Home(1C 6-1.1-7)
Name of mortgagees(tat Q a - �_
Address of mortgagee or contract sailer(number and street city,state,and
Name of asagree or other owner or holder ofmatgag -rss.ic 6 REQ."L19/ .
Addmsspf (number and street city,state, GJ ���-3 g �l7 C1 /yr •
%40{17 L
Does applicant own property in any yes,what au / min requested If yes,stela amount of deduction
other county
in Indiana? ❑Yes ❑No Yes ❑No
A person is not entitled to this deduction unless h rad indebtedness that is recorded in the county
recorder's office(inducting any home equity finer r.,.mot is the basis for the deduction.
COUNTY AUDITOR " -
Deduction approved in the amount at
•
20 20 20 20 20 20 20
Signature of CountyAudda County 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.
Sgnahme a...7—cc-P� Data(month,day year)
Full resident address of applicant(number and street dry,state,and 2112.779)
308 A wax tW't ,4Z vim, , 976G 6
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized parson (number and street ply,state,and ZIP coda)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.