HomeMy WebLinkAboutMortgage_Logsdon (3) �.� STATEMENT OF MORTGAGE OR CONTRACITTE County Township Year
FOR DEDUCTION FROM ASSESSED VALUA N J 1_i
'- State Form 43709(R13110-15)
' Presarbed by Department of Local Government Finance DEC 2 8 2017
INSTRUCTIONS: _ File Mark
TO be filed in person or by mail. Fomi filed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year r ' - is sought
Must be filed or postmarked with the County Auditor or Courr��,�$g r caPrty ttl erMbEl property is I►@•unty Auditor
located on or before January 5 of the immediately sueoeedtri9tW ar ar" '' ■ County Recorder
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(own wcontract _restrictions
/' 1 o revefsesRte)
<.k.t' feri Cierrei
Tabqg District Key number I legal•t-- .i• Record number Page number
ntrn jet lib?-/&- .F-30.7 - coac39�f 6a,8- Oil 303
Assessed vakre of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the
assessment date,arrant year assessment date,current year date of application legal or equitable owner?
gU 7 87 &' 0 Yes ❑ No
It no,what is his/her end share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of apprsant,indicate below-. Is the property in question:Annually Assessed
ICI Property ❑ AnnuallyAssessed
7— Mobile Home(IC 6-1.1-7)
Name of mortgagg a toad seller
•
Address of mortgagee 4 seder(number and street city,state,and ZIP code)
Name of assignee or other ovmer or holder of mortgage r^u\ us qq S i , Oh\' LLC
J 1..ev d`crs
Address of assignee(number and street dty,state,and ZIP code) \I c3 ��'\t WOr
Does applicant own property in any If yes,what county? What Taxi g District? g � 1 b o , O C� �-�.�1"1�
other county \ -_,3 O.- S' 'retort
in Indiana? ❑Yes ❑No au \ x .J
• A person is not entitled to this deduction unless the person has a balance on the perm _,_s.or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County • Date(month,day,yea)
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 data application is filed.
X
Signature(owners fail name) Data(month,day,year)
/✓114 .CA! ,`'�,�C ��,,V1
Full resident addrr app trfiO4 (nnuumberand street,city state,and ZIP code)
x I(OM S Maifl-. Prinrcicv' 1M 41(070
Person authorized by duty executed Power of Attorney or by iC 61.142-03 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.