HomeMy WebLinkAboutMortgage_Smith (42) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13110-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: • t iki
To be filed in person or by mail. NO V For�A rya,.
Filing Dates 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought f /Q I
Must be filed or pos marked with the County Auditor or County Recorder of the county where the property is Q County Auditor
located
ile M n or before d January
Homes 5 of the immediately Real al Properly:calendar st fil year. :C�ty�
2) Mobile/Manulsdured Homes not assessed as Real Property:Must file with the County Auditor of the con our eoorder
See reverse side k
where the r additional instructions and qualifications. (12)months before Mardi 31 of each year the�d UNTY
� AUDITOR
(owner or contract buyer
l�see resblGiorS on reverse
4
T islrict Key number description Record nu Aber Page number
4�� A - /a -olp- sea cot 7a -0 �8 U ) Y739
Assessed value of nil p as of Mortgage!Contract indebtedness unpaid as of Mortgage 1 Contract indebtedness unpaid as of Is the applicant the sole
assessment date,aurant year assessment dale,current year date of application legal or equitable owner?
oz/J MO/) ❑ Yes ❑ No
If no,what is his 1 her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below. Is the property in quesfion Annually Assessed
[Real Property ❑ AnnualyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller C ,
Address of mortgagee or contact seller(n New d sheet city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sbcet city,state,and ZIP code
o v.eAL Co. d SLewr L. k
•
Does applicant own property in any If yes,what county? �, n6�` e. l If yes,state amount of deduction
other county O 0.R.$e,0`<'Ch�`^- LV-
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the persa ?a 15 OOD .Oct l- �� ess that is recorded in the county -
recorder's office(including any home equity line of credit I i br the deduction.
."-a n 131
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty of per)ury that the above and foregoing intonation is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the afo -•--ntioned p •--rty on date application is filed.
k. Signature.�r•-• nam- Date(month,day,year)
, ._, lave/za/7
Full - - • (number a ct -u city,state,and ZIP e)
X07 ..._ /t �►�' tik 57670
erson authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,yea,)
Address of authorized person (number and street city,sate,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.