HomeMy WebLinkAboutMortgage_Oneal (3) 'a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
'('= State Form 43709(R13/10-15)
----• Prescribed by Department of Local Government Finance
INSTRUCTIONS: a°1(°fV 1.1h!(1°° N0S Hie Mark
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 del s sought
Must be filed or postmarked with the CountyAuditor or County Recorder of the county where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. , 4 833 ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County AQr ` r of me county
where the property is located during the twelve(12)months before March 31 ofeach year the deduction Ls sough t.
See reverse side for additional instructions and qualifications. (Brit . -
Applicant owner or con7a see?supports on reverse/is/0S D
0 1 w)a/J. Q .1. /n.eaJ
T 9 District Key number I le f al description Record number Page number
7 ! -0 1 312 - coo Jok oa 7 a o, S 317
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
re
assesvnt date,anent year assessment date,current year date of application legal or equitable owner?
IOn OC9a ❑ Yes 0 N
If no,what is his I 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. Is tse property in question:Annually Assessed
Real Property ❑ AnnuallyAssessed
Mobile Hone(IC 6-1.1-7)
Name of mortgagee or contract seller
v CarcU
Address of mortgagee or contract seller(number and street city state,and ZIP code)
Name of assignee or other owner or holder of mortgage I
Address of assignee(number and street city,state,and ZIP code) O�� _1 `�
oov..�\d. \I , a cast Av\y--.E
Does applicant own property in any If yes,what county? What Taxing District? 11 lion
ot other coun ty Dyes ❑No Wts,k, ka CZ C.U�
A person is not entitled to this deduction unless the person has a balance on the person: O O loo 0 5 _ lc flinty
recorders office(including any home equity litre of credit that is recorded in the county re ∎ �-
COUNTY AUDITOI '
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 information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
• MI name` ,/5/ - Date(month,day,yea')
Full • ad. .—J:apbpjfaant(number and ,state,and LP code) `��/ / —
Person authorized by duly executed Power of Attorney or 6t.t-12-0.7 / Date(month,day.yea()
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 S10,000.