HomeMy WebLinkAboutMortgage_Belcher ,�, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
e. FOR DEDUCTION FROM ASSESSED VALUATION Flit
-'% State Form 43709(R13 110-15)
Prescnbed by Department of Local Government Finance p� Y. -
INSTRUCTIONS: File Mark
To be filed in person or by mail NOV 3 2017 Form filed with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county - :the properly i ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. I •
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the Cou ^ 'i !' ❑ County Recorder
where the property is located during the twelve(12)months before March 31 of a nb
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See reverse side for additional instructions aa�nndd qualifications. /�,, ,� I
Applicant(owner o �n�o, /1 a•Q Via `tecito •
TT ngg�)istrict /X\�wC Key number/legal description Record number Page number
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Assessed value of real property as of i Mortgage/Contract indebtedness unpaid as of Mort gage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,errand year I assessment date,current year date of application legal or equdatte owner?
C?cod- ❑ yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If nacre on record is different than that of appfimrt,indicate below. _ Ls the pfo y in question:Annually Assessed
— r btZ_gal Property ❑ Annually Assessed
• Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller hr/� \
AI/ Al- -.0. -el...0 I J\ �'nn ___
Address of mortgagee or contact -/- (number and street city,state,and ZIP code) el k(� \(\f /y n0 h n Name of assignee or other owner or holder of morgage II1(� �YItI ` 1 ` l/� -Address of assignee(number and street city,state,and ZIP code) e``-"ter
Does applicant own property in any If yes,what county? what Taxing District? Has this deduction k ekC`-n —
other county , on property for
in Indiana? Yes ❑No - current year? ❑Yes. ❑No h
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is ma.....
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deducton.
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 appt•-it , S ant
owner!contract buyer of the aforementioned property on date application is filed.
grature(o/ww�n/er�,'*,s'�WY name) . war).
'J
F resident address of a /1 t(number and street code) NOV 3 2 3.7
( ml:state,and ZIP code �u'
C 9/ EEMereseA' P,•,vc eToti /4' Y? ti ya
Person author¢ by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(rran, + ayar
Address of authorized person (number and street dry,state,and ZIP code) OID:,OP: C^�J"�'v "rnn�'rr1R
The penalties for perjury can include imprisonment up to two and a hat years and a fine not to exceed$10,000.