HomeMy WebLinkAboutMortgage_Bridgewater sr STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' :`;; FOR DEDUCTION FROM ASSESSED VALUATION
. FI,_- % State Form 43709(R13/115)
LE 11,,j Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. DEC 15 2 Lnn filed with:
Filing 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 county where the pro rty is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of
',hem the property is located during the twelve(12)months before Math 31 of each year tna kThateliarCLOUVRY AU D ITO R
See reverse side for additional instructions and qualifications.
Appfxa owner or amtra uyer- restriction on reverse side)
Toxin District Keg number/le I description n r Page nu r
aC. -ab - 0 a _ AFOSI -000. 27 7,0c43 i7 ,c172?(/,',(/a
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage Arndebtedness unpaid as of Is the applicant the sole
assessment date,auram year assessment date,current year date of legal or equitable owner?
5 100 0 ❑ yes ❑ No
If no.what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of appfi ant,indicate below. Is the property in question:Annually Assessed
❑Real Property ❑ AnnuailyAssessed
Mobile Home OC 6-1.1-7)
Name of mortgagee art contract sever -
Address of mortgage contract setter tuber and 1-- city,state,and ZIP code) -- -
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mortgage
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Name of assignee or other owner or holder of rtgage J
-\-o R‘Attiz:IA }{OLaQeC —
Address of assignee(numb and street city,state,and ZIP code)
N- ryPT tort - 5ca_ ca_ —
Does applicant own property in any If yes,what county? What Taxing District? Has the
other county on limn
00
in Yes ❑No net \
• A person is not entitled to this deduction unless the person has a balance on the person's mortg
recorder's office(including any home equity line of credit that is recorded in the county recorders omoo)mar is me oars WI we uuuuwurr.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20_ 20
Signature of editor County - Date(month,day year)
I/We certify under the penalty of perjury tha . -n"re and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforem-•:.ned properly on date application is filed.
re th'ea ud-- e) --al Date(month,day,year)
/iL�+ appfcant(numbe and street city s ate,and LP code)
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Person authorized by duly executed Power of Attorney or by IC 6-1A-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 510,000. L y _.._ .