HomeMy WebLinkAboutMortgage_Duncan r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION F' LE
1'' State Forth 43709(R13/10-15)
`--12- Prescribed by Department of Local Government France
INSTRUCTIONS: _ .Fi!„Ma i . •
�
To be filed in person or by mail. MA ' _,
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is I .•,Co ',d : •••r
located on or before January 5 of the immediately succeeding calendar year. •�•;t?"f,+::, Recorder
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of thGdM$Q N C o UNT : • • r
where the propedy 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.or contit buyer-LT:ins on reverse sidt91 i
T-,: . Key I legal description Record n Page number
� 0?o-i7 460- 0 O oa9=oo/ ao J1, 3
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,current year assessrrent date,cement year date of apprxabon 27-/ legal or equitable owner?
/ ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
tf name on record is different than that of apprxam,indicate below. is the property in question Annually Assessed
yReal Ptupefiy ❑ Mobile Home Assessed
6-1.1-7) _
Name of mortgagee or contract seller /���Q
/Qmr frlc_ u"„"' �1�. 2
Address of mortgagee or contract seller(number and sheet city,state.and ZIP code)(
Name of assignee or er or of rninAL
2
i 7- 3 9 /,074/e)e,
Address of assignee(numb d sheet city,state,and ZIP code)
Does applicant own property in any 1 If yes,what county? I What Taxing District? Has this deduction been requested if yes,state amount o deduction
county other I
in Indina - r-7..__ n.. — on �i ❑Yes. D No
A person i. stance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's orded in the county recorder's office)that is the basis for the deduction.
O�4213 I g COUNTY AUDITOR
Deduction: Drawer NO
20_ 20 20 20 20 20
Card NO. . •
Signature c 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(owner's tub name) • Date(month,day,year)
�/-�� v� '�� A/ttyr Jo ^`'�
Full rf�dress of applicant(numb arc stmet.city,state,and ZIP code)
:Lcg`S2 S- 700 C F C&e-c& lv 41418
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet city,slate,and ZIP code)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. - - - -