HomeMy WebLinkAboutMortgage_Groves ta ' STATEMENT
FOR OF DEDUCTION MORTFROM GAGE ASSESSED OR CONTRACT
VALUATION INDEBTEDNESS Township Year
E
.- - State Fonn 43709(R13110-15) F
�- Presalbed by Department of Local Government Finance
INSTRUCTIONS: DEC 8 2017 File Mark
To be filed in person or by mail. Form filed with:
Filing Oates 1) Real Properly 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 county where. e pro c=.. ..,.i / ounty Auditor
located on or before January 5 of the immediately succeed-mg calendar year. I, •. U1471/a t'l
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the . .;.. Q�C661ifd(rrRyrl DITOyu County Recorder
where the property is located during the hvehe(12)months before Mardi 31 of each •' z`deduction is sought —
See reverse side for additional instructions and qualifications. rf
Ap owner r race fwyer- . . on reverse side) l y
Taxing �/,/[_J/p`- _/- Key number/legal description (XX\�rl Record number Page number
�Mg alb- sail- 7D/ 00 1. Y/6 -023 aoi 9 a6,
Assessed value of mat property as of Mortgage/Contact indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,amend year assessrr��yrt daten
,current year date of application legal or equitable owner?
I �QQ� ❑ Yes ❑ No
if no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
tf name on record is different than that of applicant,indicate below Is the property in question:Annoy`•'T;sed
al Pm,• . - -
• • tied
.6-1.1-7)
Name of mong�9(ee or contract seller c� -- -
Address o`mortgagee or contract seller(number and street ay,state.and ZIP code) .. '..
prawcr ISO•..........
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet,city,state,and ZIP code) Ca'rVdlf S10 • O
Does applicant awn property in any If yes,what county? What Taxing District? Fix _u..oquest��yes,state amount of deduCion
other county n Indiana? ❑Yes ❑No currrent year?r ❑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
recorders office(including any home equity!me of audit that is recorded in the county recorder's office)that is the basis for the 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 1 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/contract b .er of the aforementioned property on date application is filed.
Signany[e - -MI 4e Date(month,day,year)
c� 11
Full resident address.• -.. -t t(number and sleet city,state,and ZIP code) nn
8k-�1 ■ ieJ ?LC h F.Jt- crk ar In 4164g
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,Year)
Address of authorized person (number and sheet cdy,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 110;000. : - - - -