HomeMy WebLinkAboutMortgage_Loveless s. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS emu ;._Township Year
; A1-7 FOR FOR DEDUCTION FROM ASSESSED VALUATION
'- State Form 43709(R13/10-15) �S , ( '.
Presented by Department of Local Government Finance a =;
ile Mark
F
INSTRUCTIONS: _ IVU �
To be filed in person or by mail. S 657?
Fifing Dates: 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought
Must be filed orposrmarked with the County Auditor or County Recorder of the county where the property is I ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. p 7 r -
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the eI oonstyl CO -:.. 1/. -nrder
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought •
See reverse side for additional instructions and qualifications. UDITOR
Applicant( or buyat;,see respi�ps on rave side) •
T r-1 CSJ" �J,11�
/t.�x � 7cer1�, /oi-06Jai-o 3 Mori r
Assessed value of real meetly as of rfM/ortgage I Contact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as f Is the applicant the
assessment date,aurrentyear I Sassessment date,current year date of application ..��// legal or equite a er?
/j& 73a ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than*ponce,indicate with whom
If name on record is different than that of applicant,indicate below Ate property in question:Annually Assessed
Real Property ❑ Annually Assessed
///JJJ Mobile Hone(IC 6-1.1-7)
Nacre of mortgagee o contract seller/ /
eae7,2 64e/el
Address of mortgagee or contract / r(nuummber and street wry,state,and ZIP code)
Name of assignee or other owner or hoiden of •
of 441.4-./1.) �i 7CO /�/
Address of assignee(number and street city,state. P cede) iii
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ❑No anent year? ❑Yes ❑No
A person is not entitled to this deduction unless the pe '---- `-'---- -- -----'-•^^^nan=n �!Iffeefihtedness that is recorded in the county
recorder's office(including any home equity line of at sis for the deduction.
Deduction approved in the anecmt of
Drawer NO 2.0....a.
zo 20 20- // '' Q
County 20
Signature of Cnty Auditor Card NO. `�1 D Date(month,day.year)
I/We certify under the penalty of perjury that the i - . applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature s hit name) Date(month,day,year)
,/al ,r.ad // _r- -✓
Full _ i!rad:ress- .e,recant(n bet and---= city,state,and ZIP code) )
�e2 r /i!/. PI"VI .s r-r-1-c/ S.-• / .,.i—�•v /v 4/2c 7 e)
•
erson authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7 (month,da, r)
Address of authorized person (number and street,city,slate,and ZIP code)
The penalties for peg y can include imprisonment up to two and a half years and a fine not to exceed$10,000. -
co
-