HomeMy WebLinkAboutMortgage_Petitjean STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�s:� Cou Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
1'- State Form 43709 Department o �
Presrnbed by Department of Local Government Finance i;
INSTRUCTIONS: t
�;- Mark
TO be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is Song h I. �,,./
Must be filed or postmarked with the County Auditor or County Recorder of the county whet:a/he L r EF" unty Auditor
located on or before January 5 of the irmnediately succeeding calendar year ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County AuSlitor of the
where the property is located during the twelve(12)months before March 31 of each yearp))JgO,'p4l
See -verse side for add'' n instructions andqu cans.
r. .c.,♦, cons Mydr- restrictions on ___Al GIBSOP! ^0 )NTY twin I OR
�'il , I /1Vvl KW number � if � 1 r age number
• � •'► a c — b —h00 71a--baV ` p r a5Z
-4.•value of real property as of Mortgage 1 indebtedness unpaid as of M
- -- ,date,aurerd year a�ure�ntivyear/y��� eon a�p1q indebtedness unpaid as of legal or egqu�'d wvih�1
V(,(,/V V ❑ Yes ❑ No
If no,what is his/her exact share of interest? J It owned with someone other than spouse,bum with whom
if name on records different than that of applicant indicate below. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
////����AC Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sager / 1 /lC/�I 17 e .
Address of mortgagee or contract seller(num/��beer and/street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any If yes,what county? I What Taxing Disairi? Has this deduction been requested If yes,state amount of deduction
other in Indiana? ❑Yes ❑No - ,current year? ❑Yes. ❑No
A person is not entitled to this deduction unless then--' 'vice on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equitv'r-`' led in the county recorders office)that is the basis for the deduction.
p \. � \mac :OUNTY AUDITOR
Deduction approved P" \ Q, J
c7
20_�F' d to�(' 0 20 20 20
a�O't� Solo
Signature of Off" O-0 County " 1t ' Date(m. •ay
I/We ce ' w A \p0 , ,.Ht the above , ; r • information is 'e and correct and that the applicant is a resident of Indiana and
owner/contract ...'ementioo, property o • .•. .—ten is filed.
91gp3 ur his .e] �v �� Date(month.day,yeas)
/y�/e)s d�� odr�„'_,.'<c_- /vl) i' �P�� �����/(��' f� / 7 0 -a tf • e)17
>F/ r/146: $applicant(nu a�street", •.i-jan`Ir�wf/v'uosc�Li ,I'1. "t 71_2
arson authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,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.