HomeMy WebLinkAboutMortgage_Padgett e STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
_ -'• Stale Fortn 43709(R13/70.15)
v- Presalbed by Department of Loral Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. filed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction i tl
Must be filed or poslmadced with the CountyAuditor or County Recorder of the county whet . 4 I,, County Auditor
located on or before January 5 of the immediately sung calendar year.
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county • County Recorder
where the properly is located during the twelve{12)months before March 31 of each year the deduct&,isis$41.1 18
See reverse side for additional instructions and qualifications.
Apphrentgfb�con coons pn-�verse � :Q.�..Q.�-z�
Taring D" number/legal description GIB a`I
!o— /1-i� - aou - oo • gzb �. -`C Rcrd numberl O PPage m r
Assessed ratite of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as o s the applicant the sole
assessment date,current year assessment date,cement year date of a legal or equitable owner?
If no,what is his I her exact share of interest? I If owned with than ❑ Yes ❑ No
spouse.indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sutler
Address of mortgagee or contract seller(number and street, " state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and LP code ^/
Does applicant own property in any It yes,what county? 5D r 43 c❑ L D'TT a I r. If yes,state amount N deduction
other manly UK
in Indiana? Yes ❑No Drawer NO
A person is not entitled to this deduction unless the persa iess that is recorded in the county
recorder's office(including any home equity fine of credit I as for the deduction.
Card NO. I
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 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
own /contract buyer of the aforementioned property on date application is tiled.
S" re( n y Date month,day,year)
yF.W�Ippr,�/�'° Gm street. 4 O Y 1e) ai'VI,q?6, 7()
PASOn authorized by duty executed Power or by IC 6-1.1-12-0.7 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 hat years and a fine not to exceed$10,000.