HomeMy WebLinkAboutMortgage_Adler STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS nryJ
v`'�e FOR DEDUCTION FROM ASSESSED VALUATION g
Stale Form 43709(R13/10-15) ern . Year
Presented by Department of Local Government Finance r�
INSTRUCTIONS: SEpl J M a rk/017
To be filed in person or by mad. Form tiled With:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the CountyAudltor or County Recorder of the county where the prope '. '_ .1 :" i i t Shot ,
located on or before January 5 of the immediately succeeding calendar year. GIBSOt��r' i �.. Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly.Must tide with the County Auditor of the cow fr-'O U 1- ' A U I rn
The property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought ..
See reverse ' e additional instructions and?,alifcations.•
mnnaCWr�[ye//�1-see �
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Assessed value of real properly as of I Mortgage l Contract indebtedness unpaid as of • Mortgage/Contract indebtedness unpaid as of Is the appfwrd the sole .
as date,and year assessment date.current year date of won �f legal or equitable owner?
/a1/// ❑ Yes ❑ No
If no,what is his/her exact share of interest? III owned with someone other than cpnah,iadrate with whom
If name on record is different than that of appfcant,indicate below. k property In question:mA7nunaupayflyAssessed Assessed
'(�/'' //, ���( /� /) Property ❑ Mabee Home 1.1-7)
Name of ogee or contract seller e e2 y /[��.C!/.l �i (L«ly 11l3�1
Address of mortgagee or cordract seller(nunberG/and sir et,thy,state,and ZIP ZIPS code)
Name ol assignee a holler
s ?
Address of assignee( ZIP code) ( �v J
•
Does applicant own property in any If yes,what counter - What Taxing District? Has flee deducbon been requested if yes,state amount of deduction )
other in lndiana�? ❑Yes ❑No can ❑Yes 0 N
A person is not entailed 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(including any home egwly fine of credit that is recorded in the county recorders office)that is the basis for the deduction.
COUNTY AUDITOR -
Deduction approved in the amount of .
20 20 20 20_ 20 �1 �/�I
Signabire of County Auditor Cagily Drawer 1\0....0`V t —•
I/We certify under the penalty of perjury that the above and foregoing information is true and C n 1'd NO. � `^ 1
owner/contract buyer.f e -forementioned property on date application is filed.
. owner's to �/ , ()3/ col
te resident-.. /.,...•. (number and street tity,state,and ZIP code)
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I /193. 4::.-,k9r , Z /'2& 7(2,' t"/ It/40
Person authorized by duly exear wer of Niamey or by IC 6-1.1-12-0.7 ' Date(month,day.year)
Address of authorized person (number and street,oly stafe.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.