HomeMy WebLinkAboutMortgage_Ayers ss STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. FOR DEDUCTION FROM ASSESSED VALUATION
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'" State Form 43709(R73/70.15) 1
I 'S
■ Prescribed by Department of Local Government Finance _
INSTRUCTIONS: • File Mark
To be filed in person or by mail. M •T -1_.AL i
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for whidl the deduction is sought
Must be filed or postmarked with the CountyAuditor or County Recorder of the county where the properly is A ❑ Coun Auditor
located on or before January 5 of the immediately succeeding calendar year I 1•-• .i
:�•��i�.;pi,Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the �
where the property is located during the twelve(12)months before March 31 of each year the deduction�( • : - - • ir • --
See reverse side for additional instructions and qualifications.
Appicant; •er or contract.. . - _ .n reverse side)
Toxin. v�:
C� 4a % -d i m-/O E) oO.A. OG7- cy 7e RQ Z PagzeIRer7,3
`-. ---.value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
.date,aurent year assessment date,anent year data of appilcatian �f,l /yv legal or equitable owner?
/Paac ❑ Yes ❑ No
If no,what is his/her exact slave of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below: Is property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Horne(IC 6-7.1-7)
Name of mortgagee or contract seller 1 /
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or atheric-�er of O e � /� /r Jj- /I id 7 Address of assignee(number d t dty,state,and ZIP code)S1C!/L iuf l/ /�yA,�~lJ (�!(��-/f'Does applicant awn property in any If yes,what county? What Taxing /istrict?� Has this deduction been requested If yes,state amount of deduction
other county on for
in Indiana? ❑Yes El No arrreprrrlr? ❑yes- ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contact indebtedness that is recorded in the county
recorder's office(ulduding any home equity line of aedit 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_ 1 20
Signature of County Auditor 0\6( p 1 year)
I/We certify under the penalty of perjury that the above and foregoing inf D)'a 1Y C r N O.... 1 "` sident of Indiana and
owner I contract buyer of the aforementioned property on date application ��'(/
/IW, Signaw '-lavners e) `4 I . .. se.year)
�T/ �, U Al _ b/e/r�7Lntllll[1y�aL�7"vs//}I�
Card NO.
Fun ,K.., 1 fbpp tin i st y, and ZIP code)
Person au@rwize/� t
lira d (� d �.L/�/� -t�/lk!Oc-Si 12j}7 Date(month,day,)ean
Address of authorrzaperson (number and street city,state,and ZIP (codde)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.