HomeMy WebLinkAboutMortgage_Byers (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ug� '► hip Year
FOR DEDUCTION FROM ASSESSED VALUATION �{" -y it State Form 43709(R131 10-15) --!f
�-- Presatbed by Department of Local Government Finance
INSTRUCTIONS:
DEC 1•9 ?One Mark
To be filed in person or by mail. Form filed with:
Filing Dates' 1) Real Property.Must be completed and dated in The calendar year for Such the deduction is song. •
Must be filed or postmarked with the County Auditor or County Recorder of the county where , I; .a.vQ91 j/. ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Pro Must file with the County COUNTY e AUD11�FCounry Recorder
where party. ear the of n county
property located during the twelve(12)months before March 31 of each year the dedrrdbrr is sought
See reverse side for additional instructions and qualifications.
(owner or contract burn.ace reshicbons on reverse side)
rid Key number/ desCripbon r� Record number Page number
i2(/n Ce ai✓
(26,-/a- o8 - 020 y -OD( . 50a _ 0 x 8 /7 5.4.3x,3
Assessed 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,current year assessment�date,amen year data of application legal or equitable owner?
7 7D 00 ❑ Yes ❑ No
tf no,what is his/her exact share of interest? 'If arced with someone other than spouse,indicate with wham
If name on record is different than that of applicant,indicate below Is the property in question:Annually Assessed
❑Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee/Contract seller
141
Address of mortgagee or contract seller(number and street dty state,and ZIP code)
Name of assignee or other owner or holder of mortgage
D o f -S 33�
Address of assignee(number and street dly,state,and ZIP code) c� (1
Does applicant own property in any If yes,what county? What Taxhp District? �1�Q'. r' _ -tin`�CO lJ UC of deduction
other Li Yes ID No $ I tdO VU
A person is not entitled to this deduction unless the person has a balance on the i 1�' (g— 11 fin the county
recorder's office(including any home equity line of credit that is recorded in the county reooroers once)mat rs me basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of-.
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!contract buyer of e aforemen property on date application is filed.
Date(month,day,year)
F ; ...(want(num and street city.state,and ZIP co )
aroy �� � � Y74'7o
Person authorized by duty executed 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 indude imprisonment up to two and a half years and a fine not to exceed$10,000.