HomeMy WebLinkAboutMortgage_Murthy x STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
•'" t, FOR DEDUCTION FROM ASSESSED VALUATION
Stale Form 43709(R13/10-15) �1 y�
%-<:--12--, Prescribed by Department of Local Government Finance J[Nl`J� 1[Nt}
INSTRUCTIONS:
ED
To Na filed in person or by mail. CT 25 2017'3"rued with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is so
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor• - r County Recorder
where the property is located during the twelve(12)months before March 31 of each year the n::?,?"-.`�,Y.
See reverse side for additional instructions and qualifications.
GI G'•• �I� AUDITOR
Appian ( or contrail buyer-see resbicaons on reverse side)
T atria Key number description Remrd number Page number
/� ,?(o - J? -07 301 - 00 /. 0 4 0A 8 ,Z0j7 998a
Assessed value of real property as of 1 Mortgage I Contact indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
,S & (, '( O ❑ Yes 0 N
If no,what is his)her exact share of hterest? If owned with someone other spouse,indicate with whom
If name on record is deferent than that of applicant,indicate belay Is the property in question:Annually Assessed
❑Real Property ❑ Annually Assessed
• Mobile Hone(IC 6-1.1-7)
Name of mortgagee or contract seller
-� _
�N"�'s-r >t �_'-
Address of mortgagee or contract seller(number and street,city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage 1I``1
Address of assignee(number and street city,state,and ZIP code) l 1\\C l L\ •''
oti -- ..
Does applicant nt own property in any If yes,what county? What Tag District? 1 ••' o'
otter county C;11 (] O• .• deduction
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the persons mortgage or contract indebtedness that is recorded in the county
radonler's office(including any home equity line of credit that is recorded in the county recorders office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of 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 1 contract buyer of the aforementioned�property on date application is filed.
ks re( x�j.( �!V//11 )If S/J1AAA,/A1`� � f,�/GV� Date(math.day,Yeas)
F address of app Ad(nu _, a 'stole P�)' J \\l-1 1 7 / ' 0
31 / .lf /� n111YYYJJJ n' ill/// ,/.J�j/,L(iyL,r �{7, V
Person 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,slate,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.
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