HomeMy WebLinkAboutMortgage_McGregor STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS - County Townthip Year
FOR DEDUCTION FROM ASSESSED VALUATION
ry' State Form 43709(R13/10-15)
- Prescribed by Department of Local Government Finance
INSTRUCTIONS: _ File Mark
To be filed in person or by mail Po" 18
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought ❑ County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is Al
located on or before January 5 of the immediately succeeding calendar year. __ __ _•2) Mobile I Manufactured Homes not assessed as Real Property: /s A - - r
where the is located during Pefi Must file 31 the County Auditor of ion c9J�r�N ` ,
See reverse side for additional instructions ands (12)months be March 31 of each year the deduction is sou�ri I AUDITOR
qualifications.
outer-see reverse side)
-. ' Key mrmber!legal / Record number Page number
1i �� d6 - /�/ /a� -oo/• /Q-aa7 2o18 727
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,anent year assessment date,current year date of application/(� legal or equitable owner?
❑ Yes 0 N
If no,what is his/her exact sham of truest? If owned with someone other thar(spouse,indicate with whom
If nacre on record is different than that of applicant,indicate below: Its property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
f/)"
Address of mortgagee or contract seller( and street city, te,a •ZIP code)
Name of assignee or other owner or holder of mortgage - .
Address of assignee(number and street city,state,and ZIP code)
1wsyht ���
Does applicant awn property in any If yes,what county? Nfiat Taxing District? \U O 1J � \C`c71'?s 1 ation
other county 1`
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the pet 11 , U e county
recorder's office(including any home equity line of aedit that is recorded in the cox , O 6
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/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/contract buyer of the aforementioned property on date application is filed.
( Signature(oers II name) Date(month,day,year) -
t Fud�j�� a t( r aid sbeet 1 Stale,and e) L� -(n// /
�m a, 21/ L7�/„ ,WK 7 7to7ll
Person authorized by duly execute o of Attorney or by IC 61.1-12-0.7 Date(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.