HomeMy WebLinkAboutMortgage_McCarty (2) sr STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year -
FOR DEDUCTION FROM ASSESSED VALUATION
-- State Fonn 43709(R13/10-15)
"---:2; Prescnbed by Department of Local Government Finance
INSTRUCTIONS: r gy F:�I ilk,
To be filed in person or by mail. f'1 ■ I . i'�`nr:, :
Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sough 1
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is Auditor
located on or before January 5 of the immediately succeeding calendar year. ((��(('� 2 2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor of the coMtty� ` unty Recorder
where the dal instructions is located ns and the ions. (12)months before Match 31 of each year the deduction is sorghl
See reverse side for additional instructions aril r7tralficafiorts.
Applian coltitract 5 I Jti C GISSON COUNTY AUDITOR C
j i ,'/ \1 `• Key number! description U Record number Page number
- a3--o�-iO3 000 .s3s-010C
,20, tf .76
=•value of real property..of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is cite applicant the sole
assessment date,amend year assessment dam/rr/ant year date of application legal or equitable owner?
( ! 10oai ❑ Yes ❑ No
If no,what is his/her exact share of interest? if owned with someone other than spouse,inchoate with whom
lf name on record is afferent than that of appraant,indicate below: - - I,_ _��.___.._-.•__—`- -.—,e0
ed
••. )fr1.1-7)
Nacre of mortgagee of contract seller �.l..
5 a Drawer \0.... l
Address of mortgagee or contract setter(number and street city,state,and ZIP ) '/--1/
Name of assignee or other owner or holder of mortgage Ca rd NO. ` g+ \Il1^/
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any If yes,what county? Wrat Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on 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 credit that is recorded in the county recorder's office)that is the basis for the deduction.
. COUNTY AUDITOR
Deduction approved in the amount of
20 20_ 20 20 20 20 ,}{ 20
Signature ty Auditor 9 • / County - '�K� Date(moctll_daYV`a —I
I/We certify under the penalty of perjury th. : -. ve-rid foregoing information s true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforemention-f pro.- on date application is filed.
tig re(owner's r�7�r�GRameh''/'l1tu��v Iry
I r Data(month,day,year)
r AA r l'p" m�er•' s /I
Full em-;y =. of app t(n . `street city r P...e)
0 i �Yta. 1 . 1� , ;
Person authorized• duly - .-• • d-• - of Attorney or by IC 6-1.1-12 1.7 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.