HomeMy WebLinkAboutMortgage_Lambert >< STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
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Y FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10.15)
Presaied by Department of Local Government France :� � �
INSTRUCTIONS: . f - "fa •;l'
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought tt11IIm[[
Must be filed or postmarked with the County Auditor or County Recorder of the county where the propef y rs 2 2 A I m County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor ofth-grit.unty
where the property is boated during the twelve(12)months before March 31 of each year the dad .- r .i
See reverse side for additional instructions and qualifications. y.A ��%m1/tr'
rIRSOM COUNTY AUDITOR
Applian r orcwbactbuye r-seerestrictionsonreverseside)
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a /Se• » 1 Pe ICI•or■
T - District Key number/legal description Record number Page number
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Assessed •ue of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,torten year data of application „ legal or equitable owner?
/1 �/ ooD ❑ Yes ❑ No
If no,what is his 1 her exact share of interest? If owned with someone other than cp-.rice,indicate with whom
If name on record is efferent than that of applicant,indicate below. is the property in question:Annually Assessed
❑Real Property ❑ AnnuallyAssessed
• Mobile Hone(IC 6-1.1-7)
Name of mortgagee or contract seller `• o 7 /J
Address of mortgagee or contact seller(number and sliest city,state,and ZIP code) ^�//' - y"J-
Name of assignee or other owner or holder of mortgage ' I- I R.yn.h e�`'y
// !Cite Y
Address of gnee(number and street,city,state,and LP code)) l.� K-c c p-
. /tit r#'^ K
fe,/-1/1 (O V
Does applicant own properly in any yes,what county? What Taxing District? r r, ra,.-L d/1~ it—
other county c 1 n /v
in Indiana? ❑Yes ❑No a 0 i.� Q -
A person is not entitled to this deduction unless the person has a balance on the person's n. $ I 7/l _...L rded in the county
recorder's office(including any home equity line of credit that is recorded in the county rec s we deduction.
COUNTY AUDITOR
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/conA buyer of the afo -mentioned property on date application is filed.
XSignature//��/ - e ,, / Date(month,day,year)•
Full _.dress• -... - (num.: and street city,state nd LP code)
27 :ao4 0o- �r y76, Y8
P>/:.• authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for per)ury can include imprisonment up to two and a half years and a fine not to exceed$10,000.