HomeMy WebLinkAboutMortgage_Nurrenbern o., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
_, -1 FOR DEDUCTION FROM ASSESSED VALUATION FILED
State Forth 43709(R73I7415)
�-- Presorted by Department of Local Government Finance
INSTRUCTIONS: JAN 2 2018 File Mark
To be filed in person or by malt 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 orposlmarhed wfththe County Auditor or County Recorder of the•• ,.re.s- : .r-sty is unty Auditor
located on or before January 5 of the immediately succeeding calendar year. ,.t.. :j rat ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly Must ales i: •a nil•
%hem the property is located during the twelve(12)months before Masi 7t'., ear}i year the Isssought
See reverse side for addtirtnal instructions and qualifications.
Applicant(owner or condor see •onre rse eJ ^ n
sits 3/41 � 0 �(a3 -16-00D-00�.38b --Co* con 7 Pag eengr i
value of real property as of Mortgag indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment dale,cement year m ear date of application legal or equitable owner?
�� ❑ yes ❑ No
if no.what is his!her exact share of interest? / If owned with someone other than spouse,indurate with whom
If name on record is different than that of appricant,indicate betas Is the pi opal ry in question:Annually Assessed
❑Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name o finengageentrart seller n .6 j //`
/
Address of mortgagee or contract seder(number and street dty,state,and ZIP code)
__)l
Name of assignee or other owner or holder of coon• _ )
Dt N I L I 61'il-))� at Taxing District? Has this deduction been requested If yes,state amour of deduction
at `nn{ on p for
inI �� I currenty�n Oyes. ID No
• Ape r��f i I _.,.as a balance on the person's mortgage or contract indebtedness that is recorded in the county
recce I l ..r credit that is recorded in the counly recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduc .r....ea in the amount of
20 20 20 20_ 20 20 20
Signs re n itor _ County - Date(coon• ,day,year)
3 -18
I/We certify under the penalty of perjury that th- . •: --. foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signature name/) Date(month der yemJ 1 x
'ug^resident address of aapp�rican (number n�°�jstate,,and ZIP code) / /// O(1 —/
X/ zO� S e�-Nr S'vd.S,sdt /-fv y7 4 3,
adderson 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 include imprisonment up to two and a half years and a fine not to exceed$10,000.