HomeMy WebLinkAboutMortgage_Treadway CSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Stare Fonn 43709(R13/10-15)
IFILED
Presrnbed by Department of Local Government Finance
INSTRUCTIONS:
Td be fled 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 deduction Ls sought u AR 1 ,}a,
Must be filed or postmarked with the County Auditor or County Recorder of the county where the propolyis 1 2 • �'L`1 County Auditor
boated on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the••unty
where the property is located during the twelve(12)months before Mardi 31 of each the ded ,if :-.'
year ,,., b,Iihi:
See reverse side for additional instnictions and qualifications. RIR Sf)N r
OUNTV AUDITOR
A p p l i c a n t( ha buyerAsee restrictions on revs ) 1
/ ttuX� ��slfl�e
Taxing District Key number/legal dr'saiption yla Record Page nun
a6- < < —.�to- aoo - DDO - . . a-c l o121
Assessed tie 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,current year date of an legal or equitable owner?
("'Ir (561) 0 Yes El NO
ex
If no,what is his/her exact share of interest? If owned with someone other than spouse,intricate with whom
If name on record S different than that of applicant indicate bela-c Is the property in question:Annually Assessed
❑Real Property ❑ AnnuallyAssessed
• Mobie Home(IC 6-11-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and city,s&te,a� lJ vii n V.\—
Name of assignee or other owner or holder of mortgage
•
Address of assignee(number and sheet city,state,and 2/F 0 / 7 ^ 0 7 7 7
Does applicant own property in any if yes,what county? rested If yes,state amount of deduction
other county ,--, 1\'
in Indiana? Yes ❑No 0••••............... ❑No
A person is not entitled to this deduction unless the F lebtedness that is recorded in the county
recorder's office(indudug any home equity line of c Card NO. t basis for the deduction.
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County - Data(month,day,year)
I/ •-e certify under the penally of perjury that the above and foregoing information is true and tarred and that the applicant is a resident of Indiana and
• • er/contract buyer of the aforementioned property on date application is filed.
-en's foil name/ Date th day,year)
he eiel _�. .. .,,.a_ Vi= a—i �
Full • adddress-;G:f – t( • bet and dty, - ... LP code) (�
L"li 350 - r nne\ �11M1(0) b
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,state,end ZIP code) _
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.