HomeMy WebLinkAboutMortgage_Phelps STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count ownship Year
GFOR DEDUCTION FROM ASSESSED VALUATION
State Fomn 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS:
Dale ' -`I(
To be Ned in person or by mail. Fo 'P t-, :
Filing Dates 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 the property i .PI A, n Auditor
located on or before January 5 of the immediately succeeding calendar year ' ' • .tr•r
rr,:������ T.��� my Recorder
2) Mobile I Manufactured Homes not assessed as Real Properly:Must file with the County Auditor ot�idt dlu CO NT
where the property's located during the twelve(12)months before Mardi 31 of each year the deduction is sought - .
See reverse • additional in-. .i•ns and• -,rfrcations.
Apairaria.- . - ' •use�)
•--� - /legal tlesafp5rn number Page nu bar
f/7� �►�A �?0-0.3/0"1J -000. o SAS-Gb/ o / 7 ��
cceasavl value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole •
•assessment date, assessment date,current year data of application 'n// legal or equitable owner?
&it ❑ Yes ❑ No
If no,what is his 1 her exact of interest? If wined with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate belay. Ls
property in question:Annually Assessed
Reat Property ❑ Annually Assessed
•Name of Mobile Horne(IC 6-1.1-7)
mortgagee or contract seller } t /J l I !I
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(nu d sheet,cGNstate.and ZIP code) / / / J--i //do
es
Does applicant own p a dv Dyes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
� ❑ ( en�R ❑ia ? Yes o current yea 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
Deduction approved in the amount of:
20 20 20 20
Signature of County Auditor County 'AO1 �'
Dra`Yer NO
40 I t We certify under the penalty of perjury that the above and foregoing information is (� `/./ inn and
owner/contract buyer of the aforementioned property on date application is filed. u�I y
1 nature(wit full name •
Cal'( NO. 1 1111
Full
firesident address of a fxant Hum and street c+tl:Pate,and ZIP code)
17c S. OS-F FR iii>rc4 C0IN. 1/76r/q
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 street city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a hail years and a fine not to exceed$10,000. • •