HomeMy WebLinkAboutMortgage_Hobson `" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDSS ,-,./I`.. . Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10.15) S E i 2017
Prescribed by Department of Local Government Finance
INSTRUCTIONS:
File Mark
To be filed in person or by marl 4101111/1 Form filed with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the ded ...4 I w. 7 .Y AUDITOR
Must be filed or postmarked with the County Auditor or County Recorder ofth=r...:... e , r r property 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 of the county ❑ County Recorder
where the property is located during the hve/ve(12)months before Math 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications. •
` er or buyer - /i /c/0
Key number/legal dwtpuwy Record number Page number
11# -0-barn) �2/e-aa -, g -3oo ooaov .90QV • aO/ 7 3395
•..r-•value of real properly as of Mortgage/Contract indebtedness unpaid as of - Mortgage I Contract indebtedness unpaid as of fs the applicant the sole
data,aaram year
assessment date,and year data of application legal or equitable mvner7
d 8goco . . ❑ Yes ❑ No
If nn,what is his/her exact share of interest? 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:rAnunauBaylyAssessed
Weal m
Property ❑ Assessed 6-1.1-7)
Nene of mortgagee or contract seller
T /= CU .•
Address of mortgagee or contract seder(number and street,city,state,and ZIP code) -
—
Nameof assignee or other comer or holder of mortgage C.
5V.
-4-0, E T F Cl,`
Address of assignee(number and street nay,slate,and ZIP code) •
C
s , odor `s–M– li p
o�applicant own property in any If yes,what county? what Taxing District? I ` a01 – .3 3 l S Any
in Indiana? ❑Yes 0 N - Iaa-ent year/ Urea u..., r
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(mining any home equity fine of rat that is recorded hi the county recorder's office)that is the basis fir the deduction.
COUNTY AUDITOR • .-
Dedudion approved in the amount ot.
20 20 20 20 20 20 20
Signature of CowdyAnrtior 'Canty 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/contract buyer of the aforementioned property on date application is fled.
if (mvnefa full name) Date(month,day year)
kul u the4 city,4.�
Full of applicant(number and street city,state,and ZIP code)
Y // 700 5 /30 4) et 1, icci n mc/ '/ 763 9
Person authorized by duly exacted Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day.year)
Address of authorized person (number and street o7y,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.