HomeMy WebLinkAboutMortgage_Hunt (4) .. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. FOR DEDUCTION FROM ASSESSED VALUATION
State Rim;43709(R13110-15)
Presorted by Department of Local Govemment Finance
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INSTRUCTIONS: 11 1g � �
To be filed in person or by mail. Form filed wan: '
Firing 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 courtly where the properly is NO ■7 7C243>j 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 county County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is sough- • •r.7
See reverse side for additional instructions and qualifications. it nny1.
An "t(owner or contracbur3f-see restriction on reverse side) blt3SUN I.UUN I f AUDITOR
brancaon M M- Keely J Nu„" \
Taxing District 'Key number I legal desaiptioni Record number
Page number
COI 1.tc•.biq Z10— 13-x 3 - 10 1 - Oo ( . I ,5 00e0 n11 90?
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid s of Is the applicant the sole
assessment date,current year assessment date,=rent year data of application legal or equitable owner?
C9.5-599a. ga- ❑ Yes ❑ No
If no,what is share of interest? If awned with someone other than spouse,imitate with whom
H mm Is the property in question:Annually Assessed
Nai Qa f _ �'(J 9 U/ 2_ ❑Real Roomy ❑ AnnuallyAssessed
Il Mabee Home oC 6-1.1-7)
IPig
Vdi 3 ZIP code)
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Mai /
Do TOCcii �CCGt t at Taxing District? Has this deduction been requested If yes,state amount of deduction
att. on property for
in cement year? ❑Yes- ❑No
A p /� L \I/� r-t/+ balance on the person's mortgage or contract indebtedness that is recorded in the county
MC ' `� I v1 f 1�, l..Q scanded in the county recorder's office)that is the basis for the deduction.
_ r COUNTY AUDITOR
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
• con- - bu s r of e aforementioned properly on date application is filed.
Sig .� nit• e) , ,r•R-- Date(month,day,year)
f ���� ,. LtL/AvV/lVyVt •
Fug >'.- i ad. : ...ficant( mbar and street city:state,and LP code)
X18 P S•w' 9ev Cis id whl d2( 4-ti, � u1lobce
P authorized by tl Date(month,day,year)
Address of authorized person (number and street dry,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 810,000.