HomeMy WebLinkAboutMortgage_Hulen STATEMENT OF MORTGAGE OR CONTRACT INDEBTEa
•dal County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13 10-15)
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Presrbed by by Department of Local Government Finance N 47:j
INSTRUCTIONS: OV Z'l File Mark
To be filed in person or by marl 0/. / 0» Form sled with:
Filing Dates.: 1) Real Property.Must be completed and dated in the calendar year for' • s 11 :534.r;) is sought
Must be filed or postmarked with the County Auditor or County Recorder• '1a ijr• .<_, a property is XP County Auditor
located on or befom January 5 of the immediately succeedng calendar year. —Vitt, #. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the Couny4 of the county
where the See reverse side for additional instructions and qualification. (12)months before March 31 of each year, !�. ,.•4' is sought
Aporrant(oic r�m+maptouyar-see, onrevr{ses+de)
District � Key number/legal desod Record number Page number
121_41-6122011_, 2/ —( -o ,60-col / 99,Q oa co/ 7 31/4”
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole •
assess-nerd date,current year t date,.current year date of application legal or equitable owner?
9 / 7i ❑ Yes ❑ No
it no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with wham
If nave on record is deferent than that of applicant,indicate below: I Ure omrw•+v ---.. essed
Name of mortgagee a contract seller �j- l . x (IBC d 61.1-7)
Alf-- 7c-' )) �' • ....
Address of mortgagee or seller(number and street may;state,and ZIP code) D)'aw'C I- !�0,.. �!.�....
35y
Name of assignee or otter owner or holder of mortgage ....
Card \ . ...1�. ) 1..i�1l1�
Address of assignee(number and street dry,sate,and ZIP code) `�P(QOr""'-
Does applicant not own property in any If yes,what county? what Taxing District? on ura aedu been requested If yes,state amount of deduction
in Indiana? ❑Yes ❑No I torrent fel ❑yes- ❑No
• A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduchon 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 I contract buyer of the aforementioned property on date application is filed.
Signature(owner's full nom ) Date(month day,year)
u -zie i / �
/7- a 7—/-7
Full resident address of nt(number/ b st"e aJ rrd L code)C d e
Person authorized by duty executed Power of 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 perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.
—dirt.