HomeMy WebLinkAboutMortgage_Coleman a<� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou • nship Year
�' , FOR DEDUCTION FROM ASSESSED VALUATION /
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Slate Form 43709(R13/10-15) ,! i I Lg.
Prescribed by Department of Local Government Finance
INSTRUCTIONS: _ Eta Math -
To be fled in person or by mail no ! yd
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought a ?n/�)�
Must be filed or postmarked with the County Auditor or County Recorder of the county where the prp7erty is ❑ CoutttRuditor
located on or before January 5 of the immediately succeeding calendar year. uu//8S -., Ter County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the courtly Cp o -
wvhere the property is located during the twelve(12)months before March 31 of each year the deduction is sought f r ey2 s 4_See rive for additional instructions and qualifications. �Ay
Applies eror buyer-see reverse stile) / 'Uy7.._a 7ng D¢6id KeSr I number Page morn r
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Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage!Contact indebtedness unpaid as of Is the applicant the sole
assessment date,anent year assessment date,current year date of application legal or equitable owner?Nv�(lOU ill Yes 0 No
tt no,what is his/her exact sham of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below. Is the property in question:Annually Assessed
Real Property ❑ AnnualyAssessed
Name of mortgagee or contract seller �^��'7�f/J— ///�//S(//J(��// Nbbtle Home(IC 6-1.1-7)
Address of mortgagee or contract seller(num6eY and street cry,state,and IIP�)
Name of assignee or other owner w holder of mortgage
dam" 4 �C iI—�-1 �[3Srga
Address of assignee(number and street city,state,and L )
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on for
in Indiana?county , ❑No aneprntyeaR El yes• 0 N
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
r°^^-^'^^yr1A^^.r..w...a....^^''"^n°e..•.:r.,."°..r...e.cre,=t is recorded in the county recorder's office)that is the basis for the deduction.
C,∎. h, v. a . 4t kY;SV �, COUNTY AUDITOR
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a S,I� �_`mj- `� - 20 20 20 20
a0 '1 _ `i 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 the aforementioned property on date application is(tied.
Signature Ay full name) Date(month,day,year)
Sr U• i d 4U .L/' '-
Full ='•'dress of apphrant if land street,dry,state,and ZIP code)
y11,', 6/8l £ 501 A) PMlcr Yo r-) 4-764/9
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 city,state,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.