HomeMy WebLinkAboutMortgage_Naas }la STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS r.. Township Year
FOR DEDUCTION FROM ASSESSED VALUATION F�7 i
Stale Fonn 43709(R13/10-15) p ' I T: I�
�- Prescribed by Department of Local Government Finance X111-.
INSTRUCTIONS: JAN 0.4 2018 File Mark
Tb be filed in person or by mail. Form filed w ut
Fling 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" ere rty is County Auditor
located on or before January 5 of the immediately succeeding calendar year
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with f pity A6dtta'al(hey "r R County Recorder
where the properly is located during the twelve(12)months before March 31 oteach year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(own ., •• tract buyer-see restrictions pin reverse side)
itt g Dsbct.. $ Key number l legal description Record Recad number Page number
' • is4 • 2-(0-1 a-0-1 - iom 06657(1 6r- a aOJ7 0R5
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the
assessment dale,current year assessment current year date of application legal applicant rile sole
'3cco 0 Yes o o
it no,what is his/her exact share of interest? If Owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below. sj�the property roperty i n question:Annually Assessed
1 ---Property ❑ AnnuallyAssessed
• Mobile Home(IC 5-1.1-7)
Name of mortgagee or conttect seller C ')-'(G
Address of mortgagee or contract seller(number and sheet city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
earn 1°0(
Address of assignee(number and street,city,state,and ZIP code) QS
Does applicant own property in any If yes,what county? What Taxing District? V svl Ue
nxon
other
in Indiana? ❑Yes
❑NO
A person is not entitled to this deduction unless the person has a balance on the person's mu,,�`-'�-� Tea "-V he county
recorder u.
s office(including any home equity line of credit that is recorded in the county recorder's office) ....-
COUNTY AUDITOR ��
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 informations true and coned and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
lee wn(o - lull name) Date(month,day,year)
—/V._'.Z l/t. a
Futlx=-•- .address of • 1-....
P- authorized by duly executed Power of•its - or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet 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.