HomeMy WebLinkAboutMortgage_Wade (2) f STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS county Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
. !, State Form 43709(R13!10-15)
�- Presrnbed by Department of Local Government Finance ,'... � � � !f•.
4
INSTRUCTIONS: .IIA' �r- �.`
To be filed in person or by mail.
Filing Dates: 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought DEC Form filed with:
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is �f1y Auditor
located Manufactured nufactur d January 5 of the immediately Real alP pert calendar year. ❑corder
2) Mobile/Manufactured Homes not assessed as Real Properly Must file with the CopMyAudifor of the cos
where the property is located during the twelve(12)months before March 31 of each year the deducticWassp
See reverse side for additional instructions and qtr ms. a COUNTY
erGr�rarad buyer-see restricwnso use AlrnrTOR 417'fa:, • Key I description Record number Page a ber
1 o&-/9-3/-363- C •arc?-co g 07o/ 7 /z-�../{�
Assessed vain of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,curterd year assessment date,current year data of application /// legal or equitable owner?
If no,what is his/her exact share of interest? If owned with someone other that( with whom E1 Yes ❑ No
go 4-6 aa
K name on record is different than that of applicant,indicate below. Is
property in question:Actually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee sea/umber city,state, P code)
Zr 0 /0 /90
Name of assignee or other4r or holder of mortgage
Address of assignee(number and street dry,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
�
on property
inindia Indiana? ❑Yes ❑No amenyea 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(induding any home equity fine 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 ot. A _ 63- F RS'/ N
4 Y
20 20 20 20 r14Cl-I Eta [-Yid _
Signature of County Auditor County ��.... /53 7 v�G(( b,
I/We certify under the penalty of perjury that the above and foregoing information is true Fry Jens lid
owner/contract buyer of the aforementioned w P�1V1 F���l-�LW j�
buye property on date application is filed.
Signature ens fugn / l Date(month,day,year)
•
Full a /fxant(number and -N/. �p�'si/a�te,/aM LP code) 1
304 C64-, �". 1.44.,75tc. 4- �f'V LF 7'39
Person authorized by duty executed Power of Attorney or by IC 6-1.1-1247 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 hvo and a half years and a fine not to exceed$10,000. .