HomeMy WebLinkAboutMortgage_Arbuthnot STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN
' ' J' FOR DEDUCTION FROM ASSESSED VALUATIONiTownship Year
State Form 43709(R13/10-15)
•Cl- Presorted by Department of Local Government Finance 6 INSTRUCTIONS: OCT 6 2011 File Mark
To be filed in person or by mail. Form filed with:
Filing Oates 1) Real Property Must be completed and dated in the calendar year for which the deduction islsought
Must be filed or postmarked with the County Audrtor or County Recorder of the county e Eri County Auditor
boated on or before January 5 of the immediately succeeding calendar year. �n
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the�SfjQDHhf ESONTKoorny-ITOR❑ Courtly Recorder
where the property is boated during the twelve(12)months before March 31 ofeach year the deduction is sought
See reverse side for additional instructions and qualifications.
AppCman,".J2 12 trgrt _ see re.�i�aas,ie reverse side) �f
/tl/ nom/ G�f// � `mber(n /Z ui2��V�r
Datdct
Key number! description Record number Page number
• 'l an �� //_0/ ,-(ki 000 <3/y 0 0 a0/7 379y
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract• ebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
/67537 ❑ Yes 0 N
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of app&Cant,mtlimate below: Is the property in question Annually Assessed
aReal Property ❑ Mnu
. e 1 6-11-7)
Name of mortgagee or=Wad seller
Address of mortgagee or contract seller(number and t city,state,and ZIP code)
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Name of assignee or other owner or holder of mortgage / \\ r! � J
Address of assignee(number and street,city,state,and ZIP code) j\,c1N C• 5
Does applicant own property in any If yes,what county? What Taring District? 0%N. C-- O durSOn
in Indiana? ❑Yes ❑No (Z:6-1•b
A person is not entitled to this deduction unless the person has a balance on the person 76 \k,1 ■ "3-1,-1L mat is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county n ,ate\1— J oasis for the deduction.
COUNTY AUDITOI
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County • Date(month,day,year)
I f 1Ne 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 Bled.
Signaarr ( tu8 Date(month,day,year)
Full v em address of apofrant(number and net ZIP code)
LPa54 W. S'a11iin-, ve W2nsvl11.et /A/ 47tpLgS
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12.0.7 Date(month,day,year)
Address of authorized person (number and street d4' stare,and ZIP code)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.