HomeMy WebLinkAboutMortgage_Norrick (2) STATEMENT OF MORTGAGE OR CONTRA
County Township Year
�/ FOR DEDUCTION FROM ASSESSED VALU
� State Form 43709(87371615) �'-� '/
Prescribed by Department of Local Government Finance
INSTRUCTIONS: SEP 12 2017 File Mark
To be filed in person or by marl. Form tiled vrth
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year fo?rvhich n is sought.
Must be filed or postrnadred with the County Auditor or County RA ty wham the property is 0 County Auditor
located on or before January 5 of the immediately suoceedilggq qd GrepgTY AUDITOR
2) Mobile/Manufactured Homes not assessed as Real Property-Must t file with the Cotmty Auditor of the county ❑ County Retarder
whew the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications. .
Appfcant(owner or contract buyer- resfrtdians on reverse side)
Lh4 9- Kan • LI)
Taxing DDj Atha( nn Key number/legal description Record number Page number
a44,4)m.ti ( 3o—/Y-i9 -/D / CCo77/:Cc 7 • . a0/�j - `i'795
Assessed value of real properly as Mortgage/Contract indebtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
essrssmert date,aarert year assessment 7date,current year data of application legal or equitable owner?
• cC t ❑ Yes ❑ No
If no,what is his 1 her exact share of interest? If owned withsomeone other than cprarso,ind,,ah,with whom
•
If name on record is afferent than that of applicant,indicate below: Is the property in question:rAnnually Assessed Assessed
I \y -Viz,v-O Annua lame 1.1-7J
-•l/..J/I:)'i.�_, , -# \(cur tv. �OIY\G •
Address d mortgagee or contract sager(number and street city,state.and ZIP code) Cr(5_1,4 s%,„...,,,,,_ p
•Name of assignee or other owner or holder of mortgage ' \ �b\'\-C1 i5
. A -aS 1000
Address of assignee(number and street ay,state,and ZIP code) \1—1-\l{
Does applicant own property in any If yes,what county? - What Taxing Disc m oeauctimn been requested If yes,state amount of deduction
Indiana?other county in ❑Yes ❑No Iaarr�mtyean for ❑Yes ❑No
.4 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(mdudmg any home equity fine of aedrt that Ls recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR "
Deduction approved in the amount at
20 20 20 20 20 20 20
Signature of CountyAudirw County Date(month,day,year)
I f 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
rhea'
/poJwwnn^aea-r`(contract buyer of the aforementioned property on date application is filed.
/✓ (G;:cj er's lid ) G% r Date(month,day,year)
Full resident address of a ice t�street,city,state,�M ZIP c de l(.
la C/Y/
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12.01 Date(month,day.year)
Address of authorized person (number and street ogy,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.