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HomeMy WebLinkAboutMortgage_Sisk Jr STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co T Year .r''toil FOR DEDUCTION FROM ASSESSED VALUATION � � i'- Sate Form 43709(R13/10-15) Presarbed by Depart eM of Local Govemment Finance INSTRUCTIONS: - NOV'q T p"097 To be filed in person or by mail. Form filed with: Filing Dates 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought Must be f i l e d or postmarked w i t h the County A u d i t o r or County Recorder of t h e county where the prope I ..in unty Auditor 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 daialtatthiC O U . !YI SS cerder whem the property is located during the twelve(12)months before March 31 of each year the deduction is sought See rave -; side for additional instructions and qualifications. Appfican owner or contract buyer o m side Taxdn. :°.. Key r legal number Page number -/ I i//4- as- OW P97 al/ a6/ 6232 slue.``.� property .+ Mortgage I indebtedness unpaid as of Mortgage I tract omit ess unpaid as of Is the appNCarrt the sole -.Tent•-�ie7• -'year assessment date,ainent year date of Ge_bc��//aT71 legal or equitable comer? ! a ❑ Yes ❑ No H no,what is his I her exact sham of interest? If owned with someone other Nan spouse.indicate with whom If name on record is different than that of applicant,indicate felon i Is lik property in question Annually Assessed Real Property ❑ Annually Assessed • Mobfe Home(IC 6-1.1-7) Name of mortgagee or contract seller in B� / i1 ` Address of mortgagee or contract seller(number`and oly,state,and ZIP code) 6:),S2 Name of assignee or other owner or holder of mortgage o' �� S dE /9-,-// -IfiAe_-) Address of assignee(number and street city,sate,and ZIP cod j 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 pmprrty for in Indiana? ❑Yes No current year( ❑ El 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 line of credit that is recorded in the county recorder's office)that is the basis for the deduction. COUNTY AUDITOR Deduction approved in the amount of . 20_ 20_ 20 20 I 20_ I 20 I 20 Signature of County Auditor County 01000 — 0738 _ • Drawer NO _ I/We certify under the penalty of perjury that the above and foregoing information is Ind owner l good buyer of the aforementioned property on date application is filed. O Xr lyre '(`'_� Card N I re fu?name) [ 2 Full resident address of applicant(number and sheet,city.state,and ZIP code) , 2g ta a & ©/J 5/2 GS r,,f(/r e I N 4-)&&5% Person authorized by duty execuatl Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year) Address of authorized person (number and street city sate,and ZIP code) The penalties for perjury can indude imprisonment up to two and a half years and a fine not to exceed$10,000.