HomeMy WebLinkAboutMortgage_Higginson g STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ' County Township Year
t`' FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709(R731 10-15)
Presabed by Department of Local Government Finance
INSTRUCTIONS: g p11:f!
To be filed in person or by mail. Ftn:
Filing Oates" 1) Real Properly.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 where the propartnis, ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. �I�v UU VV 7 (1 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the banal instructions is ions a during the twelve(12)
months before March 31 of year the�duGiat/�Aotrc�t
See reverse side aid itional irtstructiorts arrdqua ns. ,lNl°Lt�.AvprKam(owrerw ¢vy nseeeresa on e) I 'I ., IBSONCOUNTYAUDITOR
.-. Cf ` 1� 1,2/ —^K1 /� r�'�l / Re 'J m/�m �
Key number 7legc 1C..oC �y' v Oo .. //7—& `f' ;n / 1 b5 3
—-""-•value of real property as of Mortgage indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
i date,current year �w� date of applicatron legal or equitable o neR
000 ❑.Yes- ❑ No
If no,what is his/her exact sham of interest? / If owned with someone other than spouse,indicate with whom
If name on record is different than that of appricant,indicate below. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Hone(IC 6-1.1-7)
Name of mortgagee or contract seller /3
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street oty,state,and ZIP code)
Does ap ------,n any I lives,what county? I What Taxing District? Has this deduction been requested If yes,state amount of deduction•other co on in Indiar n a=nent yam? ❑Yes ❑No
A perso Drawer NO �-�/ ,a on the person's mortgage or contract indebtedness that is recorded in the county
reoorde ...Y:O/ �' rd in the county recorder's office)that is the basis for the deduction.
:OUNTY AUDITOR
Deduct LIDS-2)
Card NO. ......`
2_ C rat oco
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 I contract buyer of the aforementioned property on date application is filed.
re(own ina e) -_ - --- Date(month,day,year)
\F/}in resident aa�dN//LLtlreesss/ of (number and sheet city,state,and ZIP code) ,/�
�o 128/'! S sit Dr NaUbs+ru/f 9
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,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.