HomeMy WebLinkAboutMortgage_Dougan a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
z FOR DEDUCTION FROM ASSESSED VALUATION
�'� State Form 43709(R13/10-15)
`,_ Prescrbed by Department of Local Government Finance
INSTRUCTIONS: _ OC r Fill mark
1 r
To be filed in person or by mail. . Ff',°_.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 where We pm..Ay, , •_, County Auditor
located on or before January 5 of the immediately succeeding calendar year. GfaSOfu!.,�,' ��i i'1 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the'domayvlyr
when:the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought 1 O
See reverse for additional instructions and qualifications. R
Apphcan ortF/trad Vresfiotto///r]]]u�r ise side) Page number
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Assessed value of real property as of �,Vr�Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of is the applicant the sole
assessment date,current year assessment date,current year date of application .9 owner?
❑legal or equitable owneYes ❑ No
tf no,what is his/her exact share of interest? if owned with someone other than spouse,indicate with whom
It name on record is different than that of applicant,indicate below` is property in question:Annually Assessed
Real Property ❑ Annually Assessed
{'/-`�y�� Mobile Home(IC 61.1-7)
Nacre of mortgagee or contract seller eta"? /�/%' 2eit-
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage n
Address of assignee(number and street,city,state,and ZIP code)1 //� /e /1e / n —J2 / �-e
Does applicant own property in any If yes,what county? /[.WWhat Taxing District? lJl/Has this deduction been requested If yes,state amount of deduction
other on property for
in Indiana? Yes ❑ =rent rent 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 tine of credit that is recorded in the county recorders office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount ot.
20 20 20 20 20 I 20 —_I--20
Signature of County Auditor County
• tOVGA0, KYLE
I/We certify under the penalty of perjury that the above and foregoing information is ti 1 ,0 r n4„) fjf )g 5 1a and
�r1 owner/contract buyer of the aforementioned property on date application is filed. I–I 0 ryl �'� /1
I� r %///:// full name) t"t(lr:,coi4� f"►yrr`j� X
,, —... address of applicant(number and city,slate,and ZIP code) /(.0 -5:26a
IOo p. . a' -. l ..
Person authorized by duly executed Power of Attorney or by I c 5-1.1-12-0.7 (uare(MOM,clay,year;
Address of authorized person (number and street city,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.