HomeMy WebLinkAboutMortgage_Alden STATEMENT OF MORTGAGE OR CONTRACT IND S'+
it
.�fs'z: FOR DEDUCTION FROM ASSESSED VALUATION �ar ' u TONfs'Ip Year
..
State Form 43709(R13/10.15)
— Presorted by Department of Local Government Finance AR ct% 2\\
M
INSTRUCTIONS: File Mark
To be filed in person or by mail. • vi Form filed with:
Filing Dater 1) Real Property.Must be completed and dated hl the calendar year for which the .
• c11-,,,•r '( (�-,•
Must be filed or postmarked with the County Auditor or County Recorder of the •: ..011. c•i : .Ptrty OR County Auditor
located on or before January 5 of the immediately succeeding calendar ye,,3�rrc1SON ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file idr85Tte County Auditor of the county
where the property is located during the twelve(12)mantis before March 31 of each year the deduction is saint
See reverse side for additional instructions and qualifications.
Applicant t° Ke �a side) i
Key
number f legal descnptwn Record n Page number
2(v-1 a -07--4/0aCax� Q'4f 6a 11//
Assessed value of real property as a Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the apparard�sole
assessment dare,amen year assessment date, y � R
ear date of appfxation legal or eque earner?
-"-/3 600 ❑ Yes ❑ 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 apparent,indicate heloes is the property in question:Annually Assessed
eat Property ❑ Annually Assessed
• Mobile Horne(IC 6-1.1-7)
Name of mortgagee or contract seller ri/5 _ -._
Address of mortgagee or contract seder(number and steel 04 2.,-Nacre of assgnee or other owner or holder a xwr Wage Drawer NO., `S Address of assignee(number and street dry,state,and LP a> \;-6)---Card NO.
Does applicant own property in any If yes,what county? 'oersted If yes,state amount a deduction
other county
-
in Indiana? ❑Yes 0 N • • 0 N
A person is not entitled to this deduction unless the pens,.,......__,.._..__.._._-_.__.._... _ debtedness that is recorded in the county
recorder's offico(including any home equity line of credit th
edcredit that is recorded in the county recorders 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 correct and that the applicant is a resident of Indiana and
owner 1 contract buyer of the aforementioned property property on date application is filed.
Signatu -P / tn��1 i� !J i - Date(month,day year)
Full = r- cat!)of 1appacantV (num, sheet o$:state,and LP code)
- 1U S .sMu i VI/mat-al 7N 141olo
Person authorized by duly executed Power of Attorney or by IC 5-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet city,stare,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.