HomeMy WebLinkAboutMortgage_Hartley STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun _ , Township Year
e. FOR DEDUCTION FROM ASSESSED VALUATION
State Fonn 43709(R13/10-15)
l(Qnd Nn�� N .
- Presorted by Department of Local Government Finance
.80 a,1llr/--
INSTRUCTIONS: •
File Mark
76 be filed in person or by mail. QQ MC nn filed with:
Filing Dates: 1) Real Properly Must be completed and dated in the calendar year for which the dedudifs7so�Kt
Must be filed or postmarked with the County Auditor or County Recorder of the county where the pro.- is County Auditor
• located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobde/Manufactured Homes not assessed as Real Property:Must file with the Co •"net of th=in
where the property is located during the twelve(12)months before March 31 of each .P--,,,'; F'.• ught
See reverse side for additional instructions and qualifications. �8
(owner or con dryer-see terse
M cc v 7 " n
T � strict mrmber/�description Retard number Page number
n�, / - 05 - 57- 09a -Goo, /co - 0/7 am C, ?
Assessed value of as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of the applicant the sole
assessment dad, year assessment date,current year date of application legal or equitable owner?
l 75 6/0 ❑ Yes ❑ No
tf no,what is his I her exact share of interest? If awned with someone other than spouse,indicate with whom
If name on record Is afferent than that of applicant,indicate below Is the property in question:Annually Assessed
ca Real Property ❑ Annually Assessed
( Moble Home(IC 6-1.1-7)
Name of coo contract seller
✓1 t /l5/4- -
Address of mortgagee or contract r(number and street cd3:state,and ZIP code)
Drawer NO... 61
Name of assignee or other owner or holder of mortgage
Address of ��
assignee and street dry;state,and LP code) Card �r0.
Does applicant own property in any If yes,what county? what Taxing District? .,equesteo It yes,state amount of deduction
other in Indiana? ❑Yes ❑No lcurrenp�fir? ❑Yes• 0 N
• A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorders 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,year)
I I We certify and r the penalty of perjury th the above =nd foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/co uyer th n:• -• prope date application is Ned.
Signature( full n A ) /s Date(month day,year)
Y - _ 7 .( ?41-/8-
Full r of applicant .- and_- dry, -,:.,> antl ZIP cod � p
X 33/ 9 •' '�rt� 4Xa7Io �f7lo�(0
Person authorized by duty executed ••i- of Ahomey or by IC 6-1.1-12-03 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.