HomeMy WebLinkAboutMortgage_Granderson s STATEMENT OF MORTGAGE OR CONTRACT INDEBTED Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Stale Form 43709(R13/10-15)Prescribed by Department of Local Government Finance
INSTRUCTIONS: MAR 1 5 2018 File Mark
lb be filed in person or by matt Furor filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the ded is sought ��\ rrr�iir
Must be filed or postmarked with the CountyAuditor or County Recorder of the count re the s. �U County Auditor
located on or before January 5 of the immediately succeeding calendar year. PAtL1 / ❑ County Recorder
2) Mobde/Manufactured Homes not assessed as Real Property:Must file with S tpe
whem the property is located during the twelve(12)months before March 31 of each year the ucBm�R
See reverse side for additional instructions and qualifications.
Apptirant h(own/er w tract buyer-see resaiclions on reverse „,, ' / j Cl-c1. () lk�,-) um -~`gal�' p+°' / �'
T Key mrrttber! Record n Page number
a,co Cr) a Lo-aa /y - 305 /. / 5 -c 4' ib 45
--,value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
—\ mend date,current year assessment date,ant year data of legal or equitable owner?
•
If no,what is his I her exact share of interest? 4J I if owned with than spouse,indicate with whom ❑ Yes ❑ No
If name on record is different than that of appraant,bM'Kate I—AO/�YeUtt((JLfl �'q} ,Iss the property in question:Annually Assessed Assessed
contract /I l[.tt `t C-9 " " 4- Roue°'Property ❑ Ville 11-7)
Name of mortgagee an(— 0 t_flicf"'i /)
Address of mortgagee or contract seller(number and shoe d0/8- /095
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,oily,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
in Indiana? ❑yes ❑No currennty ar? ❑Yes- 0 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 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 coned and that the applicant is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is fled. _ _,_ _.
Signature(• -„ 'names Date(month,day,year)
f. i
all resident address of applicant(number and street city,state,and ZIP code)
applicant
S . s�.o s�l»,1�n,. al) irM35
Person authorized by duty 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,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000. .