HomeMy WebLinkAboutMortgage_Garrison (2) � a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State F 43709(R13/10-15)
FILED. ate Form or Prescribed by Department of Local Government Finance p I,,E
INSTRUCTIONS: llliii 1� pile Mark
To be filed in person or by mail. "1 f'T 544171..t(11/ Form filed with:
Filing Dates' 1) Real Properly Must be completed and dated in the calendar year for which the deduct U
Must be filed or posbnarhed 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 ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with th�ea Co r�- rill
where the property is located during the twelve(12)months before March 31 r6 f6S 4- r r r sought
See reverse side for additional instructions and qualifications. J N,Y AUDITOR
°1 t( or contract buyer-see restrictions on reverse side) t�
171 r .6I a- (1/2 J)01 ,.2A �_ljl)1)/ 0
Taxing District J Key nurture/legal descriptor Record number Page number
Y c g i'r 9 L l i g )) 2%O -/rc - /d / OO of �= )o2 7 2-O/ 7 yY 7
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contra&indebtedness unpaid as of Is the applicant the sole
assessment date,aurerd year assessment date,anent year date of application legal or equitable owner?
306,ei0 ❑ yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse.mdxate with whom
If name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
❑Real Property ❑ AnnualyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sellerA( /� -- - -
Address of mortgagee or contact seller(number and street city,state,and ZIP code) II/`'ll ++
Drawer NO.. . 01.1....
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street ay,state,and ZIP code) Card N O. L! cI �C
Does applicant own property in any If yes,what county? What Taxing District? Has this ceam:um peen requesreo I n yes,slate amount or°edtrcmn
other ❑Yes ❑No currents ❑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 aedit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount ot.
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!contract buyer of the aforementioned property on date application is filed.
S(g ru8nam r Date(nrwNr,day,Year)
b ' � N OWU�IIti
Full address orapp t(number and ty state,and ZI )
Person authorized by duty 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.