HomeMy WebLinkAboutMortgage_Crothers ,aa STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS county Township Year
;140. FOR DEDUCTION FROM ASSESSED VALUATION
�'- State Form 43709(R13/10-15)
Prescbed by Department of Local Government Finance V1
INSTRUCTIONS: F lattil r
lb be filed in person or by malt Formfiled with:
Filing Dates 1) Real Properly Must be completed and dated in the calendar ar for which the deduction is sought (/ Qp �nn
Must be filed or postmarked with the County Atrdtor or County Recorder of the county where the property is COtYnty P3N r
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 of the county �'� County Recorder
where the properly is located during the twelve(12)months before March 31 of each year the deduction is sat,s w v.�
See reverse side for additional instructions and qualifications. ON COUN-ry A.
Appfwen ter;7. ,.. buyer- on 7 sid? „At n - oic)
a�
Key nu !/legal description 8 Record nu'/m1I`ber Page member
,' , •
Mortgage CCr� indebtedness� 3/3ortgag indebtedness unpaid s of Is the applicant 195
assess.._ dad,. -..year assessment date,current year date of application q legal or equitable owner?
4 br 6 60 ❑ Yes ❑ No
If no,what is his/her matt sham of interest? If owned with someone other than g1fer•.indite with whom
If name on record is(Efferent than that of applicant,indicate below- ` Is property in question:Annually Assessed
Real Property ❑ Annually Assessed
• Mobile Home(IC 5-1.1-7)
Name of mortgagee or contract seller P ` n �^
Cam/ ,e,Address of mortgagee w contract seller(number and sleet ray,sP cede) ajj Name of assignee w odner owner or ge n / J /
Address of assignee(number and street ' ,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on pmp��•for
in Indiana? ❑Yes ❑No , anent y«n ❑Yes- ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contact indebtedness that is recorded in the county
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 deduction.
COUNTYwrrnrrne_ - -- --
Deduction approved in the amount of-. \`�` �, 1k_9— 11
20 20 20 20_ I�3r� A. 4 Se. rsL
Signature of County Auditor ( C,�'A�e_f'S —k-r-) (fi r y-c 'n. Inte4ri�N
•
•
1 C3CV�C we 1 O
I/We certify under the penalty of perjury that the above and foregoing inform 2 a p t0 O .0 0 liana and
owner t contract buyer of the atom ntione_; seedy on date application is f
• Signature(•� s• w . • / / I Date(month,day,year)
1, AO 77
FWI •---•=p a •Arlan number- •street city,sate,and ZIP code) �"
e- i - Ce/f1/S,c-c%�Gejdtr// / z air sv/£-tr�cd 11_2 665
P=r authorized by duty executed •• -r of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sleet dry,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.
r.rr a