HomeMy WebLinkAboutMortgage_Armstrong ep^, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS my Township Year
Apt, FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(RI3l 10-15) II j j-d
Prescribed by Department of Local Government Finance
INSTRUCTIONS: SEP 12 2017 File Mark
To be filed in person or by mad. From filed with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is
Must be bled or postmarked with the County Auditor or County Recorder of the o e property is M'Auditor
located on or before January 5 of the immediately succeeding calendar year. �r(1R ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property.Must (to1i bl A?fdt 4ita&nty
where the property a located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
cbuyer-see runs on reverse side)
T District 'Key rylfnber/legal desaiption Record number Page number
1"Jon t c ( -/7 -oF? QOO oo5 5/7oo2 / c?ni7 c2 00 a.
Assessed value of nisi property as of Mortgage/Connect indebtedness unpaid as of - Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment dais,=rent year v,md date,anent year data of application legal or equitable owner?
G -V06 ❑ Yes ° No
If no,what is his/her exact share of interest? It owned wit.someane other than spouse,indicate with whom
if name on record is diforrnt than that of applicant,indicate below: Is the property N question:Annually Assessed
, J eal Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Karim of rood�gW ry
Address of�mort(gaaaagggeee�f_'/� r semi(number and street,city,stale,and code)
Name of assignee or other owner or holder of mortgage 020/ 7 - 0200 a ----
Drawer NO
Address of assignee(number and street ray,state,and ZIP code) .
Doss applicant own property in any If yes,what county? • What Taiping District? Nast Cara NO, n
other county in Indiana? ❑Yes 1:3 No aura .
A person is not entitled to this deduction unless the person has a balance on the person's mot unty
recorder's office(including any home manly fine of credit that is recorded bn the county records
COUNTY AUDITOR " - -
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor Count/ 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 filed.
5gnylw,(omer's fug r>7, )�,�(/ _ d Date(month,day,year)
Full resident address of applicant(number and stu/n�s state,and ZIP code) /� _
y 51-25 3 /O)St ) IJCVt7USV/Luc IA) 4-7� �S
Person authorized by duly executed Power of Adorney or by IC 61.1-12-0.7 Date(month,day.year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for penury can include imprisonment up to two and a half years and a fine not to exceed$10 000.