HomeMy WebLinkAboutMortgage_Cummins (2) at STATEMENT OF MORTGAGE OR CONTRACT INDEBTED �� Township Year
,: g�} FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance DEC 22 L U I
sail
INSTRUCTIONS: File Mark
Tb be fled in person or by mail. I Form filed with:
Filing Oaten 1) Real Property Must be completed and dated in the calendar year for lvhidl the ded -4•f! 1'•
Must be filed or postmarked with the County Auditor or County Recorder of Il�g a' r!y':��'- is ❑ County Auditor
located on or before January 5 of the immediatety sung calendar yeaP • 'UNTO R ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the properly is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
ApplicaM�(ownerq 2.I/`�
Record ntanber Page number
//y�/�Q/r (,tiJ� arc r4 303 -voo. a. yy . off L aor7 /Ci 1 g
Assessed vahue of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
asse..w nt date,current year assessment date,cement year date of�" legal or equ�bte owner?
J nil Q ❑ yes ❑ No
If no what is his/her exact share of interest? If owned with someone es than spouse,indicate with whom
If name on recoil is different than that of apprxant indicate below: a pmpety in question:Annually Assessed
Property ❑ 1.1-7)
Name of mortgagee or contract seller ,{
L-1' C �LCiYti '/" 4 ; -- i � LLG
Address of mortgagee or contract seller(numbs and sheet,dA:state,and LP code)
Name of assignee or other owner or troller of mortgage
Address of nee(number and sweet,dty,state,and ZIP code)
Gc a_ot-.d. 31-1a IT 1.3 (13 Pr
Does applicant own property in any If yes,what county? Mat Taxing District? Has this deduction been requested If yes,state amount of deduction
IInniManaty ❑Yes 0 N coun � ❑Yes- 0 No
• A person is not entitled to this deduction unless the person has a balance on the person's mortg..ge -" that is recopied in the county
recorders office(mdudmg any home equity line of credit that is recorded in the county recorder's o _ --
COUNTY AUDITOR D rU 15 C!• l`\rO 9 -
Deduction approved in the amount of ...............
•
20 20 20 20 2C Card 11'0. .................
Signature of County Auditor County •
I
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/contract buyer of the aforementioned property on date application is filed.
S re(owner name)/h (/'�� . Date(month,day,year)
rI`
\Xr n recida/rt address of liant(number hand street '1�A .and Code) �}_. 2-1-)G4-
a.o S. G() oJc 6-11-12-0.7 -NU g Date(month,day,YEA by IC\ Person authorized by duly executed Power of Attorney
Address of authorized person (number and street city,slate,and LP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.