HomeMy WebLinkAboutMortgage_Riggs (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS county , Year
FOR DEDUCTION FROM ASSESSED VALUATIO
State Form 43709(R13I 10-15)
Prescribed by Department of Local Government Finance Jv
INSTRUCTIONS: File Mark
To be filed in person or by mall. • A ter,.
Ring Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. `�I/
Must be filed orposbnarked with the County Auditor or County Recorder of the county where the properly is A ❑ County Auditor ,
located on or before January 5 of the immediately succeeding calendar year. • err .
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the CountyAuddor off/683i:p j", ea.-61'A/j�^ ar
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought" , v -
See reverse side for additional instructions and ualifications. Y AUDITOR
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Ti7District Key number/Iegai Record Pagrnumbe
Ccs/co/?x . -L?-/a- o 'Sl ixW- a—aaa ,n 77��
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of • Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment dale,anent year assessment date,current year date of appThodimp 00 legal or equitable(miler?6a9. ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than yam,indicate with whom
If name an record is different than that of applicant indicate below: is 9ww property in question:Annually Assessed
T' eal Properly El Annuagy{Assessed
Mobile Home(IC 6-1.1-7)
Nana of mortgagee or contract seller ,r/3 /.32,�z
Address of mortgagee or contract seller(nun and street,city,state,and ZIP code)
Name of assignee or other caner or holder of mortgage '
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Address ofassignee(number and street thy,stale,and ZIP a I ,/ 1
Does applicant own property In any If yes.what casdyl quested If yes,slate amount of deduction
other in ihdiana?? Oyes ❑No R-. R\i s �O ''� 0 N
A person is not entitled to this deduction unless the per. J ndebtedness that is recorded in the county '
recorder's office Including any home acidly fine of ore° 1e basis for the deduction.
COUNTY AUDITOR " • '
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of CousdyAudta County Date(month,day,year) •
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the appicant is a resident of Indiana and
owner/carted buyer of the aforementioned property on date application is tiled.
Spp rrelpfl name) n \ Date(month,day,year)
full ent address of 9IIcant(n Ihr1/4'
treet,c4 sae, ZIP codde�7\ L-lts' ica4) r Ir 0 t h l 0_, 117(9(PS
Person authorized by duty executed Poser of Attorney or by id 6-1.1-720.7 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. _ _ __