HomeMy WebLinkAboutMortgage_Monroe S.. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-,_ FOR DEDUCTION FROM ASSESSED VALUATION
:' .- State Fenn 43709(R13/10-15) g
�— Prescribed by Department of Local Government France
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INSTRUCTIONS:
To be filed in person or by malt. �q¢ry�k�with:
Filing Dates 1) Real Properly:Must be completed and dated in the calendar year for which the deduction is sought S F P (�,! 2017
Must be filed or posbnarked with the County Auditor or County Recorder of the county where the property is lJ County Auditor
butted on or before January 5 of the immediately succeeding calendar year.
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county •❑ Co viler
where the property is located during the twelve(12)months before March 31 of each year the deducfion_is6COUNTY AUDITOR
See reverse side for additional instructions and qualifications. GG��
Appfra ( or contract buyer-see restrictions on side)
Taxing Di .l(ey mx / Record number Page number
k . )+..a.cC) a - (Q-\t T ,00a ) 06 fs- oa -( a.v 11 `ion to
•..t.�>•value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
--; - date,current year assessment date,current year date of application legal or equitable owner?
aL{ a� b5D ❑ yes 0 N
If no,what is his/her exact share of interest? If owned with someone other than spouse,bnduate with whom
If name on record is different than that of applicant,indicate below-. I Is the property in question:Annually Assessed
Skeet Property ❑ AnnuagyAssessed
Name of mortgagee offontract seller
at-4-.0 r c r ' \T' —
Add res3of mortgagee or contract seller(number and street city,state,and ZIP code) Drawer NO...seU 1
Name of assignee or other owner or holder of mortgage (�
Card NO lu ... _
Address of assignee(number and street city,state,and ZIP code) .
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county ,--, property for
in Indiana? Yes ❑No current year? ❑Yes. ❑No
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(including any home equity line of aedit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDROR
Deduction approved in the amount at
20 20 20 20 20 20 20
Signature of County Auditor County - Date(month,day,year)
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 I contract buyer of the aforementioned property on date application is filet
Signature(� me) �/ Date(month,gay,year)
F resident address of applicant f(number anand city,state,and ZIP s g
�Z code),
VP / jisiL
VP 5 roe Dr l'vc' 1 a arl"fr 1476 39
Person authorized by duty executed Power of Attorney or by IC 5-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street thy,state,and ZIP aide)
The penalties for penury can indude imprisonment up to two and a half years and a fine not to exceed$10,000.