Mortgage_Bennett (2) ,.}.1a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
E`' FOR DEDUCTION FROM ASSESSED VALUATION T
�'� State Form 43709(R13 110-15)
Prescnbed by Department of Local Government Finance _FIT ED
INSTRUCTIONS: • File Mark
lb be riled in person or by mail. DEC 28 20 form Hied 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 posbnarked with the County Author or County Recorder of the county where the properly is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor oil
where the property is located during the fwei a(12)months before Math 31 of each year Ed 8 9b6,rs"1? Y ACM I i OR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer- restrictions on reverse side)
a d� C� cam, (� -n-Y%
T . atrkt Key number I legal description Record number Page number
tea' aG - /l - l`f- ion - oo`f. ra87 - o �t7 2,-o17 377o
Assessed value of real as of Mortgage/Corded indebtedness unpaid as or Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
If no.what is his/her exact sham of interest? If owned with someone other than suicide,8 e, 3 intricate� ❑ Yes ❑ No
whom
If name on record is different than that of applicant indicate below. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller C-
Address of mortgagee or contract seller(number and street city,state,and ZIP e)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street dry,state,and ZIP code) - - -
\' JJ J Q
Does applicant own property in any If yes,what county? Mat Taxing District? min
-
other -� F,rst ��b«-;'( F,ve_��.�
in Indiana? ❑Yes ❑No �,_..i
• A person is not entitled to this deduction unless the person has a balance on the person's 1-aC - '\lat t 33(a , o O *unty
recorders office(induding any home equity line of credit that is recorded in the county re a Q t 1 -3 -1-1 o - 1--1-1-7
COUNTY AUDITOI
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 I contract buyer of the aforementioned property on date application is fled. .
XS g re(owners full name) Date(most,day,year)
G
address of t(number a94 sheet cii4 state,and VP code)
7 ca/Clef N. /DO Y � Tiv *igen o
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 ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. .