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HomeMy WebLinkAboutMortgage_Bledsoe (2) !Cs r. STATEMENT OF MORTGAGE OR CONTRACT I EB-DN County Township Year £ FOR DEDUCTION FROM ASSESSED VALUATION er '. State Fonn 43709(R13/10-15) �-- Prescribed by Department of Local Government Finance T 3 0 2�17 INSTRUCTIONS: _ File Mark To be filed in person or by mail. T ' Form vied with: Filing Dates 1) Real Properly:Must be completed and dated in the calendar ye p�gidgdurfia`is$'At f Must be filed or postmarked with the County Auditor or County r 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 I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county where We property is located during the twehe(12)months before March 31 of each year the deduction is sought See reverse side for additional instructions and qualifications. Applicant(• ,-r�or contract buyer-see on side �, d ry 4 i _ T "strict Key number/legal descript on Record number Page number .IU1CYVJ ,e47( a -r 7-419 -ran a c oc79y axe 1 ySlos Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as Is the applicant the sole assessment data,anent year assessment date,anent year date of application legal or equitaNe owner? 3/350a ❑ Yes ❑ No If no,what is his 1 her exact share of interest? / If owned with someone other than spouse,intricate with whom ' If name on record is different than that of applicnt,indicate belt*. Is the property in question:Annually Assessed ❑ Real flupedy ❑ Annually Assessed • Mobile Home(IC 61.1-7) Name of mortgagee or contract seller Address of mortgagee or contract seller(number and sheet,tlty,state,and ZIP code) - Name of assignee or other owner or holder of mortgage Address of assignee(number and bet city,state,and ZIP ca O.� 1lI ✓ ' '. Does applicant own properly in any If yes,what county? 5 guested If yes,state amount of deduction other county CaI-cINO. �L, f,..{. in Indiana? ❑Yes ❑No ❑No A person is not entitled to this deduction unless the per& iebtedness that is recorded in the county recorder's office(including any home equity fine of credit ___..._._..-,W.,,ot,wuer s once)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" e( e Date(month,day,year) r � w' � tier Fug resident , I••• ` ' , ` state,and ZIP code) y - �© 5 'r AlUL Person authorized by duly execiuted Power of Attorney or 1 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 hat years and a fine not to exceed$10,000. -