HomeMy WebLinkAboutMortgage_Reed (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
i0. T � Township Year
State Form 43709(R13 1 10-15)
Presaled by Department of Local Government Finance ®g
INSTRUC7IONS: File Mark
70 be filed in person or by mail. DEC 1 5 2017 led 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.-/I County Auditor
located on or before January 5 of the immediately succeeding calendar year. a
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Cou aenh. . • - 711i� R ❑ County Recorder
where the property is located during the twelve(12)months before March 31 of t"
See reverse side for additional instructions and qualilifications.
Apptcant Tor abuyer- resbictions�rse - ) Jo
L/ J /Yy /rL/1 [�,w/�+%J
T 99 J Key number/legal description l� Record/nuumbber/ Page number
/r
Assessed/slue'!of as of _Mongagt Cbntrad/�Vebteda�unpaid. of 1{ ga�ron_tragrudebtedness unpaid as of s the �m/ihe sole .
assessment date,current year arse _ equitable owner?
33 I ...7-3 5 ❑ Yes ❑ No
If no,what is his I her exact share of interest? r If owned with someone other than spouse,indicate with whom
If name on record is different than that of appfimm,Indicate belovn le the property in question:Annually Assessed
eal Property ❑ Annually Assessed
' Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller
-LECITI Address of mortgagee or contract seller(number and street city,slate,and ZIP code) - —_
3311 � ?�. -..
Name of assignee or otfherawner or holder of mortgage Drawer NO....
Address of assignee(number and street city,state,and ZIP code) f
•Does applicant own properly in any If yes,what county? What Taxing District? - I Card NO. -�w
I
other county r,
in Indiana? ❑Yes ❑No Curtem year r u h ea- u nu 1
• 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 oh
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 name Date(month,day,year)
Full�V / Japp n tuber arM Sir ,tyV Pwde) �Stee .bfe4 VO/ / / 44
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 dry,state,and ZIP code) - _ _
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.