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HomeMy WebLinkAboutMortgage_Lewis (16) a� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year i =`-1 FOR DEDUCTION FROM ASSESSED VALUATION State Fonn 43709(R13110-15) Prescribed by Department of local Government Finance INSTRUCTIONS: . • 1 Fll_•Mark _ To be filed in person or by mail. Form filed - Filing Dates 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought 7 L Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is FEB U County Auditor located on or before January 5 of the immediately succeeding calendar year. ❑,Court y.Reoorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county where the properly is located dieing the twelve(12)months before March 31 of each year the deduction is sough See reverse side for additional instructions and qualifications. :r0714 rnu 4TY AUDITOR Apgica (owner or contract buyer-see,eancrions on reverse side) ""Tarn D' J Key number!legal tlesvipfion Rec mber Page number f , xCb acs, - Cs- a`t - 4-D ( -or,a . F59 - ©a( S �(os Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole assessment date,current year assessment date,arrant year - date of application legal or equitable owner? Cl 1 Atom !Ares ❑ No If no,what is his/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 the property in question:Annually Assessed Property 0 Annually Assessed l Mobile Home(IC 6-1.1-7) N of mortgagee or contract seller elerr� ,rV �YJ11S? S • P r Address of mortgagee or contract seller(number and street city,state,and ZIPP code) - —_ Name of assignee or other owner or holder of mortgage . Address of assignee(number and street cry,state,and ZIP code) --6 � C C i a�-7`0. ISO' o�applicant own property in any It yes,what county? What Taxing District? h y, t all O, O O ... • 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 uruo,..o....____ rnty recorder's office(including any home equity line of credit that is recorded in the county recorders 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 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 contract buyer of the aforeme '10°ned property on date application is filed. Signature ir pyyti�/ / / Dare P,,...dh.car.re�ad ANIL(nu and thy,state,and LP code) / / 3o, L/�,/, 3 , • A 4 /en-rn e� ' L(20 Ov P= authorized by duly executed Power of Attorney or by I .1-12-01 Data(month,day,year) Address of authorized person (number and street city,slate,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.