HomeMy WebLinkAboutMortgage_Martin (10) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
1-=;'?r FOR DEDUCTION FROM ASSESSED VALUATION
'° State Form 43709(R13/10-15)
<-1-‘- Prescribed by Department of Local Government Finance
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INSTRUC77ONS: • File a _
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To be filed in person or by mail No I/ P fi with:
Fling Dates 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought J [U17
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.
E1 . Recorder
' 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CourityAUditor o •{!! � w�,�i_
see re side��n stst instructions and dq�ifca�ns. (12)months before Mardi 31 of each year the deduc t_"'!t ,•,•Ulil Y AUDITnR
a G see on vgrsr a side)
Z :1;:ie, 01 /4—/ - ao 5L 4°7 a 7- Q46 ni i / 3�F
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract in�d/ey�tedness unpaid as of Is the applicant the sole
=rent
assessment date,=rent year assessment date,cement year date of application/ 2o960 ry
legal or equifabte owne
❑ Yes 1:1 No
If no.what is his/her coact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of appfcant,indicate belay. Is the property in question:Annually Assessed
❑Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee Of contract miner
Address of mortgagee or contract tuber and street city, .and ZIP code
Name of assignee or other owner or holder of a") n _ r(1_
Address of assignee(number and street a0:scat 1' NJ✓�r^OX* '
er
Does applicant own property in any If yes,what Drawer N O 9 D1 7 an requested If yes,state amount of deduction
other
in Indiana? ❑Yes ❑No es. ❑No
A person is not entitled to this deduction unle /� Ict indebtedness that is recorded in the county
recorders office(including any home equity) Card NO. J is the basis for the deduction.
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 perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner f contract buyer of the aforementioned property on date application is filed.
iSignature 2.1 'name Date(month,day,y�
Fog -�'+ddress of.-. - t • mbar and-••- '///' /��/�
city,state,and LP code) 2/7a / /
/2 3 duly %)--6---by f IC 'z ro.Y n i1-C/ei�/ f1 t Date month,day.year)
Address of authorized person (number and street city,state,and ZIP code) / i _
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.