HomeMy WebLinkAboutMortgage_Tinsley .,.. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
AytFOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
Prescn'bed by Department of Local Government Finance 1
INSTRUCTIONS: �.' File Mark
To be filed in person or by mall. Fonn filed with:
Fling Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is*o40 no
Must be fled or postmarked with the CountyAUddor or County Recorder of the camtyrnir 1hbl pbFry is 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 County Auditor o the ❑ county Recorder
where the property is located during the twelve(12)months before March 31 of each sought
See reverse side for additional instructions and qualifications. v AUDITOR
AeWca Towner contractbuyerrsee onrererseside) - �7;.St:'S .
GIBBON t•
Ta bipt.T. Key number/legal desa n ( Record Page number
,,////..�-�. h -/ a -o 7-'/K) S�o�-P 1 - 3311
Assessed value of feat property as of Mortgage I Contract indebtedness unpaid as of - Mortgage I Contract"Indebedn ss unpaid as of Is the applicant the sole
assessment dale,natant year assessment date,arrant year date of application legal or equitable owner?
(p C.r,Q Q ❑ Yes ❑ No
If no,'Mat is his l her exact share of interest? If owned with someone other than spouse,indicate with whom
C name on record is dfierem Can that of applicant,Indicate below Is the property in question:Annually Assessed
- • ad Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Nave of mortgagee or contact seller
Address of mortgagee or contract so amber and street city,state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage '
wn
•
Address of assignee(number and steel ray,state,and ZIP code) -
Does applicant awn property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other unty in diaann?? ❑Yes ID No • orient year? ❑Yes 0 No
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 '
recorders office(inducting any home egwly fine of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR • - .-
Dedurtion approved in the amount of
20 20_ 20 20 20 20 20_
Signature of CountyArddor 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 applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
4: (owners MI name) ne Date(month,day,year)
r //�ZC y a eilA•,Dona)
Full resident addre -of applicant(number and street,city,state,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC fi'1.1-12-0.7 Date(month,day,year)
Address of authorized prized person (number and „and ZIP code) •
2O ' F, ,Owl-0i h(FJ +m, ill 471Q70 - - -. -
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000. - •