HomeMy WebLinkAboutMortgage_Anderson (5) �.,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS • 4 IjM ;ip Year
t-::ft FOR DEDUCTION FROM ASSESSED VALUATION I Ins w
�'� State Form 43709(Ria/1015)
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Presorted by Department of Local Government Finance
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INSTRUCTIONS: File Mark
lb be filed in person or by mad. n , >.with: -
Fi6ng Dates: 1) Real Property Most be completed and dated in the calendar year for which the deduction is soug'g; . —.arm jta, [fir^,,
Must be Ned or postmarked with the County Auditor or County Recorder of the county where pe •lis. aU�q oxnty Auditor
located on or before January 5 of the immediately succeedng calendar year. GIB � LJ
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor of the county County Recorder
where the pmpedyis located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Apat'ite (owner o contraatbbuyyer-see msvicaars on reverse side)
T Athol Key purr /Iegal desaiptiori Recorrd number Page number
A�of real prope of of Mortgage I Contract indebtedness un _ 001 . 8 ge eZ —O 1-/ v as / 3 s p .
assess. date,current y assessment date,current year as of of 1 Contract indebtedness unpaid as of Is the or equitable the sole
9 legal or equitable owner?
d no,what is his/her exact share of interest? If owned with someone other than spouse, ❑ Yes ❑ No
spouse,mtlicate with whom
If name on record is diferem than that of applicant,uuficare below. lb the in -
PreP�Y� question:Amm�n._- ---1
Name of mortgagee or ct seller ( ` ' I
Address of mortgagee or contact seller(number and street,city,state,and ZIP code) I 1
Name of assignee or other owner or holder of mortgage I
of assignee(number and strut,city,state,and ZIP code)
Sw SE 3fo-d- -0-- c. 31 3 A- L _ �� O C b�
Does applicant own property in any N yes,what county? What Taxing District? Has thi 7 l ✓ 5 O • I
Mara? ❑Yes ❑No current \ �+ 1\q
• A person is not entitled to this deduction unless the person has a balance on the person's mortg `— `—n
recorders office(including any home equity line of credit that is recorded in the county recorders1
COUNTY AUDITOR 1 r
Deduction approvedin the amount of. \ ao \I -3s.3'
20 20 20 20 2d ___J
_
Signature of County Auditor County Date(month,day,year)
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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 r contract buyer of the aforementioned property on date application is filed.
Signature pi name) Date(month,day,year)
(
resident address of of applicant(number and street city,state,and ZIP code)
Icsg/ ‘-, 4-1s0 S o-„E, cv?l/F 2-„ 117/Er
Person authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.