HomeMy WebLinkAboutMortgage_Sisk ��. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
*I'sse FOR DEDUCTION FROM ASSESSED VALUATION
�'` State Fonn 43709(R13110-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail.
Form filed with:
Filing Dates' 1) Real Properly 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 property is ❑ County Author
located on or before January 5 of the immediately sung calendar year
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county ❑ County Recorder
where the proper1yis located during the twelve(12)months before March 31 of each year the deduction is sought
See m rse side for additional instructions and qualifications.
• n (ownerorcontra buyer- rse s'u`
Taxing n l — (NO- 100— D04r 311-0a1 ' T Pazi nfibieja
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as or Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment des,current year assessment date,current year date of
1 `''S) legal or equitable owner?
If no,what is his l her exact share of interest? If owned with someone other than ❑ Yes ❑ No
spouse,indicate with whom
If name on record is different than that or applicant.indicate below: erty in question:Annually Assessed
( 'roperty ❑ Annually Assessed
•
Name of mortgagee or contract seller l 1 5 X Mobile Ftortne(IC 61.1-7)
Address of mortgagee or contract seller(number and street city st J O 5e P'4
Name of assignee or other owner or holder of mortgage TS-1)r
u
Address of assignee(number and street city,state,and ZIP code) ///��� l {� ,(�(1� �A r% /S
•
Does applicant awn property in any If yes,what county? / , t 1 I Q,I``�• /�' f yes,state amount of deduaio n
other county U1/ 1/�/
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person ha: /) ' / 31 :that is recorded in the county
• recorder's office(including any home equity line of credit that L 1 1- !/ ('/J111 he deduction.
Deduction approved in the amount oft 1 V q" '
Jr�'
20 20 20 I I zu 20 20
Signature of County Auditor County - Date(month,day,year)
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 1 contract buyer of the aforementioned property on date application is filed.
ignafure( full name) 4;4 Date(moth,day,year)
-
• address of applicant(number and street city,state,and ZIP code)
Co 9 79 w N)S S. O wens p;//e rti N J 6 66" —
on authorized by duty 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 ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.