HomeMy WebLinkAboutMortgage_Dunigan STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
t. FOR DEDUCTION FROM ASSESSED VALUATION M® County Township Year
State Form 43709(R13/10-15) F I Y� N '_
Prescribed by Department of Local Government Finance Jt �.�./
INSTRUCTIONS: SEP 15 2017 File Mark
To be filed in person or by mad. - Form fled 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 County Auditor or County Recorder of the county �Rra the ' County Auditor
located on or before January 5 of the immediately succeeding calendar year. `f fd'IYMCgyify(Xa my Recorder
2) Mobile/Manufactured Homes not assessed as Real Property.Must Re with tie Qp.}4ot(I;o�y/Qlie aQ-aaiyl0 R _
where the property is located during the twelve(12)months before March S1 of each year the deduFton is sought.
See reverse side for a =instructions a.,• qualifications.
Applicant(owner or ; - , ,. . -verse side) ■ I -
�� 0� • t ,(/x,
: IT loateL Key number
—/8_3x3 —coo. 7 -o ar aa"' � iaas
Assessed value of mal property as of Mortgage/Contract indebtedness unpaid as of • Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date current year assessment date, date of appli ation legal or equitable owner?
(r5I0 Da ❑ yes ❑ No
If no,what is his Hier exact share of interest? / If owned with someone other than spouse,indicate with whom
•
If name on record is different then that of appfrant,indicate below. is the property in question:Annually Assessed
❑ Real Property ❑ ArmuaO%Assessed
/�
Whale Home QC 61.1-7)
fiat of mortgagee or contract seller 6 Jo_ ^ n •
Address of mortgagee or contact seller(number and street,city,state,and ZIP c/coder/e))/n
Name of assignee or other owner or holder of mortgage '
DQ U N-I-v / What Taxing District? Has this deducimrx been requested If yes,state amount of deduction
of on property for
in _ current year? ❑Yes 0 N
A p k �) Sas a balance on the person's mortgage or contract indebtedness that is recorded in the county
reC �x 1 it is recorded in the county recorder's office)that is the basis for the deduction.
ST EV E I• el-i aa5 COUNTY AUDITOR
Deg
20 20 20 20_ 20 20 20_ -
Sigretne of 0 County Date( ye
I/We certify under the pe•alty of perjury that the above an rmafion is true and coned and that the applicant is a resident of Indiana and
owner f.• I.., buye o e a rn .- -• property on date application is filed.
Signahue(. ;Ii.. ` y. ,y/ I 4 a Data(•• •Or ay,
Fun'- - ,address .••. .- .(n and street ally,state. - :ZIP code)
5c)a. E S- rain S 1=k R(a>+r�_CM �� In ��
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and steel ally,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.