HomeMy WebLinkAboutMortgage_Denu }tea STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
1'- State Form 43709(R13/10-15) P
- Prescribed by Department of Local Government Finance rs
IN S7RUCTn person _
RI eft
To be fried in person or by mail. Form
Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought. Ni b.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is r 0 County
located on or before January 5 of the immediatety succeeding calendar year. (;�� * El Cct( Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor Well/iggl••,: .
where the property is located during the twelve(12)months before March 31 of each year the deduction is's`du
See reverse side for additional instructions and fificafions. O ��
(ygher (JAr- ���
Applicant yf oonfpC buyer-see verse sCe) •,Y-iLr -
1f(/Jq (L///U OJT.,
pini -�'. , mbar/ desaiprtion Record-/9-lie „loci-pod . .A0--7-4,71 G 7r l D9
Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant the sole
assessment date,amend year assessment date,current year date of application legal or equitable owner?
4/5;630 0 Yes 0 N
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 applicant,indicate below.: is property in question:Annually Assessed
Real Property ❑ Annually Assessed
///7' Mobile Hare(IC 61.1-7)
Name of mortgagee or contract seller
/n `
Address of mortgagee or contract seller(number and street,sty,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP aw+e•
1 S
S . k\Cw\.-�--
Does applicant awn property in any If yes,what col 7\i `e"r �� >•f
1 'equestetl If yes,state amount of deduction
other county in Indiana? ❑Yes ❑No bI\QC_ Do tTh ❑No
A person is not entitled to this deduction unless t hdebtedness that is recorded in the county
recorders office(including any tame equity line, E \3t j,o6 . C O ie basis for the deduction.
Deduction approved in the amount of \I- c5- n
20 20 20 20_ 20_ 20 20
Signature of County Auditor County - Date(month,day,yea)
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 t contract buyer of the - •rementianed property on date application is filed.
Signatur r.-•ens era . •) Date(month,day,year)
X r g i 1 212(7
P-. a . '•ed by duty - -..-d Power of Attorney or by IC 6-1. -12-S7 Date(month,day.yeas)
Address of authorized person (number and street sty,state,and ZIP code)
The penalties for penury can include imprisonment up to two and a half years and a fine not to exceed$10,000.