HomeMy WebLinkAboutMortgage_Jones (12) ,� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou AEI=ip AN..Year
kf'c FOR DEDUCTION FROM ASSESSED VALUATION I
State Form 43709(R13110-15) I,
�- Presabed by Department of Local Government Finance { �
INSTRUCTIONS: - N ' 1M U 18
To be filed in person or by mail. Farm filed with
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is soughs •
Must be filed or postmarked with the County Auditor or County Recorder of the county where the c�ryy i unty Auditor
located on or before January 5 of the immediately succeeding calendar year. SON COUNT'96tliNsi corder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse •- for additional instructions and qualifications.
t .. , or con cf bygr-see resa7ci /t.[.G//C/!.w Q i�f
T..; 1• I ;. y (/�_, Key (/ I desrriPtron ' �tA Read number Page number
d .,KJ 373 4, -0 111,`�- 4�� c2ol7 _ 33,73 ,
- value of real property as of Mortgage/Contract• ebtedness unpaid as of I Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
data,arrrent year assessment dale,current year date of appliiation legal or equitable owner?
0 Yes 0 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-. I Is the property in question:Annually Assessed
x1,1(Real Property ❑ MnuatlyAssessed
• ///
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller /J/ / / // .
Address of mortgagee or contract serer( mbber and city,state,and dZZIIPJcoodf fie) /�/� J�7
Name of assignee or er r or holder of ape
� � i3 - 76 /01693
Address of assignee num er I street city,state,and ZIP code)
Does applicant own properly in any If yes,what county? hat Taxing District? Has this deduction been requested If yes,state amount of deduction
county pyryMa? ❑Yes ❑No current year?for ❑Yes- ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 --- r ---_- j—20
Signature of County Auditor Cox
Drawer NO 20 (m .
I/We certify under the penalty of perjury that the above and foregoing informati �� f Indiana and
owner f contract buyer of the aforementioned property on date application is file ^'"'��
Signature full e) Card NO.
�. - ba .
Full resident address cif apprrant(n tier and street city,state,and ZI code)
�. SY y E l3 S E/her f� z—�/ �l 76/3
Person authorized by duty executed Power of Attorney or by IC 6-1.1-i2-0.7 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 half years and a fine not to exceed$10,000. - - - - .