HomeMy WebLinkAboutMortgage_Pearson STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
`#'" ,t, FOR DEDUCTION FROM ASSESSED VALUATION ��
State Form 43709(R13/10-15)
`— Presabed by Department of Local Government Finance J PD
INSTRUCTIONS: kit- k
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To be filed in person or by mail. Pore'filed` 7
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 where the property is / ❑ County 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 of the wwxQN �. rr.1¢`- • -i rder
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought c h.
See rave -- side for additional
Record number Page number inn
Assessed value of real property as of /Mortgage/Contract indebtedness unpaid as of I Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of appl' / legal or equitable owner?
/ Qr1(O ❑ Yes ❑ No
if no,what is his/her exact share of interest? I If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is property in question:Annually Assessed
eel Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sellerL//•+/) u
Address of mortgagee or contract seller(number y,state nd ZIP
Name of assignee or other owner or holder of -i�' xixiii _ �x�
�i p� O ;/' /mil//
Address of assignee(number and street,city,state,and/.•e)
Does applicant own property in any If yes,what county? What Taxing District- —I.nix this deduction been requested I If yes,state amount of deduction
other county q _ _
in Indiana? ❑Yes El No u 1 , (� — --
A person is not entitled to this deduction unless the person has a balance on Ih t ~�Y w ' `f ear-$o I(�9- 11 h the county
recorders office(nduding any home equity tine of credit that is recorded in the 41. '^J r, -A
COUNT IBC '' 2Ce K. �e.arS �,O
Deduction approved in the amount of C.e.� C Ave■CL n _ ty�,
(' �A- 1' CC ,3 . �A r Fi.
20 20 20 20 cad I1 � 1 y, 11�, y (4.o0 20
Signature of County Auditor County -
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!contract buyer of the aforementioned property on date application is filed.
Sigramr name) Date(nrundr,day,year)
�f���'7
F • or applicant(nu arM cal:state and ZIP code)
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Person authorized by duly executed Power of Attorney orbr IC 61.1-12.0.7 '`� " Date(month,day,year)
Address of cudmhiced person (number and street city,state,and ZIP code)
•
The penalties for perjury can include imprisonment up to Iwo and a half years and a fine not to exceed$10,000.
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