HomeMy WebLinkAboutMortgage_Perkins STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.°..=_rJ FOR DEDUCTION FROM ASSESSED VALUATION
•' ,. State Form 43709(R13/10-15) Fir
S�'? Presathed by Department of Local Government Finance
INSTRUCTIONS: • File M1a^rk .,
To be filed in person or by mail F64(n 4,a,
filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought °v 200
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is • County Auditor
located on or before January 5 of the immediately succeeding calendar year. (f;;��°° 1�'II! „u i-carder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the cowap Sp SSz,ft
where the property is located during the twelve(12)months before March 31 of eadn year the deduction is sought T y .
See revs for additional instructions and qualifications. .�l AUDIrn
�,[�l o /1� � W2 4 /lid
f
T l.. . Key nu /legal/..lo'. Record n ber
1 o-c-,��,v - - 0o - 6cc?. oft/-&?c" ciO '7j
�- --•value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid of Is the applcant sole
. ,date,and year assessment dale,anent year date of application coo legal or equitable owneR
cU o ❑ Yes ❑ No
If no,what is his I her exact share of interest? I If owned with someone other than spouse,indicate with whom
If name on record is dfferem than that of applicant,Vacate below. Is 01/property in question Annually Assessed
( � Real Property ❑ Annually Assessed
• 7 D7 dei e1 Wbnae Home(IC 6-1.1-7)
Name of mortgagee or contact seller (.Q.M
Address of mortgagee or contact seller(number and beet ray, and DPP Qai/,Name of assigneewother ovmer or kidder of sa (e , �/J/I/. v // - �i{r(J/
Address of assignee(number and sheet illy, ,rte -,,U-code) [�U�J
Does er applicant own property in any If yes.what county? I What Tar I-1 this been requested If yes,state amount of deduction
in Indiana? ❑Yes ❑No 11)D aurent year? ❑Yes ❑No
A person is not entitled to this deducti^-- — 5,— ` rson's mortgage or contract indebtedness that is recorded in the county
recorder's office(including.—� ,, it S I �1 tty recorder's office)that is the basis for the deduction.
SEE-VSS , ` , /P ti !TOR
n
Deduction approved the am NV N V
20 2 ,n i AA 20 20 20
Signature or 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 filed.
Signatures full name) Date(month,day,year)
`r Full resident address of applicant(number and street city,Yale and Vie)
L' ' H763/Y9ZG E wi„rit, o / f,
Person authorized by duly executed Power of Attorney or by IC 5-1A-12-0.7 Date(month,day,year)
Address of authorized person (number and street ray,state,and VP code)
The penalties for penury can include imprisonment up to two and a half years and a fine not to exceed$10,000.