HomeMy WebLinkAboutMortgage_Nossett (4) � STATEM
FOR DEDUCTION ENT OF MORTGAGE FROM ASSESS OR CONTED VALURACT ATION INDEBTEDNESS County Township Year
'`° Slate Form 43709(R13!10-15)
C--". Prescribed by Department of Local Government Finance 1 I IPile Z1�1
INSTRUCTIONS: -
To be filed in person or by mail Form filed with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought An
Must be filed or postmarked with the County Autior or County Recorder of the county where the property M N 2 4a Ginty 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 of the coot
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 quafiffcatio - ),ITIP�KC�}µf(.UA
,1.. erwcontraa• -see on,eve. -) - �1 GIBSON GOuN fY AUDITOR
1/ __r. •sr/ IF 01 / / AI TI, / ,O
T"tC vaatrict -` �•- /legal desai t;: . Record number
/ Page number
/ - -/?/ '1 dai100/• 77:57-QO '51 do/.5- qt./6
Assessed value of real property as of I Mortgage/Contract indebtedness unpaid as of I Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment dace,current year assessment date,current year date of application legal eg or equitable owner?
If no,what is his I her exact share of interest? If owned with someone other than
11 Yes ❑ No
spouse.indicate with whom
If name on record is different than that of applicant,indicate bebx Is
Property in question Annually Assessed
Real Property ❑ AnnuallyAssessed
Name of • Mobile Home(IC 6-1.1-7)
mortgagee«contras seller SCy, �{ c a /�-.GL e i
Address of mortgagee or contract seller(number a s7aa,and ZIP mile) !!
Name of assignee or other owner or holder of mortgage
Address of assignee(number an, y city,sta- •LP code)
ro L yM /,0—�/0 J.JJg�
Does applicant own property in any .es,what county? at Taxing District? Has this d-"— -•^••�+a1 -I If ves.state amount of deduction
other county on proper 1
in Indiana? ❑Yes ❑No cement yr ci.,i\r\5:-\-c3
A person is not entitled to this deduction unless the person has a balance on the person's mortgal 11l., `" 6 s SE 4
recorder's office(induding any home equity line of credit that is recorded in the county recorder's A/ (1 .,Ss C C L N V
COUNTY AUDITOR v
Deduction approved in the amount of CO'^^�k..V\L�V \SC-h
4 ally 0oa . Ov 11-IL-AS 20 20 20 20 21 ,
ao15- 4s-(-1
Signature of County Auditor County '
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!contract buyer of the aforementioned pro erty on date application is filed. \
44
Sig e( shill name) Data(month,day,year)
u � .44- /umber3 ,Z eft
F resident ad of t(number and street,city,state,and ZIP code)
1. L//O/ E, SO, S Ai, Lei/ L/767o
Person authorized by duly executed Power of Attorney dr by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,sate,and LP sae)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.