HomeMy WebLinkAboutMortgage_Duckworth ,&_ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
FOR DEDUCTION FROM ASSESSED VALUATION Lr 111f�,
'• State Fonn 43709(R131 10-15) g'1
cL-- Prescribed by Department of Local Government Finance "J
INSTRUCTIONS: - JAN 2 4 2P; Mark
To be filed in person or by mad. Form filed with:
Filing Dates 1) Real Properly Must be completed and dated in the calendar year for which We deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the • •pedy is• E.- County Auditor
located on or before January 5 of the immediately sung calendar year. rt ,. : 111101;'
2) Mobile/Manufactured Homes not assessed as Real Pro Must file with the Cou ❑ County Recorder
Property: ear the deduction dug AU lTr1R
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Appfxant`�copa_ f�tYer see side)
1/Y,Fl7�r+�-,i/� �number/legal description Rend number Page number
T i v 024, "Vol - /r - /0/ -003. y $ 3 -0 J-8 ,LO f ? 530 !0
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the
assessment date,current year assessment date,current year date of applicabl(� -7 legal or�puuitable owner?
ii no,what is his I her exact share of interest? If owned with someone other man spouse, ❑ Yes ❑ No
tf�spouse,umtlicate with whom
If name on record is different than that of applicant,indicate belay. -Is era
_
p_rorperry'v m question:Armuatly hssesstd
teal Property ❑ AnnuallyAssessed
Mobile Horne(IC 6-11-7)
Name of mortgagee a contract saner - ,
— -___
Address of mortgagee or contract seller(number and eat city,sate,and ZIP code) ___.:_�_..._
Nance of assignee or other owner or holder of mortgage Drawer N O..✓:. I
Address of assignee(number and stoat miry,sate,and ZIP code)
Card NO. ..... . CeC2
Does applicant awn property in any If yes,what county? What Taxing District? ' luchon
other county - .....
in Indiana? ❑Yes ❑No
• A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebttedness that is rewrueu nr gyre 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
Dedumon 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 coned and that the applicant is a resident of Indiana and
owner I contrail buyer of the aforementioned property on date application is filed.•Signature ma.. //fdRnarp Dale(month,day,year)
W addles of applicant(nu and sheet city,Sate,and ZIP code)
`6 5 SAL L4411 �'t:-C<f 49y-,t-t3.,-PA s U 4 7 42 7 0
Person authorized by duy exeaned Power of Attorney or try IC 6-1.1-12-0.7 1 Date(month,day,year)
Address of authorized person (number and street dry'state,and ZIP code)
The penalties for perjury can include imprisonment up to twv and a half years and a fine not to exceed S 10,000.