HomeMy WebLinkAboutMortgage_Alldredge (2) r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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= FOR DEDUCTION FROM ASSESSED VALUATION y
State Form 43709(R73/10.15) FILED
Presabed by Department of Local Government Finance II,/��
INSTRUCTIONS: File Mark
To be filed in person or by mail. MAR 29 Z14 filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the Courtly Auditor or County Rwvnder of the county where the pro.-rfy is • • my Auditor
located on or before January 5 of the immediately succeeding calendar year. ';r,I •
.-�•'n11 orm County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of
where the property is located during the twelve(12)months before March 31 of each year th Ni( tTY - • e e
See reverse side for additional instructions and qualifications.
t(owner or contract buyer 1C�-'
s�e� on reverses side)
T Key rnrmber Record number Page number
a (0- / a - o9 - /0 / - coo - 0 -7 - 0 a 8 2o05 7So4
Assessed value of real property as of Mortgage l Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
Dr O0 p ID yes 0 N
If no,what is his/her exact sham of lrterest? If owned with someone other than spouse,indicate with whom
If name on record is afferent than that of applicant indicate below: Is the property in question:Annually Assessed
❑Real Property D AnnuafiyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or=tract seller L _ .
Address of mortgagee or contact seller(number and y�Rstreet,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage _
Add 6 of assignee(number d city,Nate,and LP code) 1070°°- _ - __—
d-Vae /{
Does applicant own property in any If yes,what county? What Taxing District? Ha r 2/ / I 2 r
other county in Indiana? ❑Yes a Drawer \0.........••.,.
❑No an
A person is not entitled to this deduction unless the person has a balance on the person's m unty
recorder's office(including any home equity line of credit that is recorded in the county reco Card Na ,,,...,}SG�
COUNTY AUDITOR •
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County Date(math,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is tare and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's frill name) A / Date(month,day,year)
t N rn W v/////�
Full resident of applicant(number and street state,and A- -
X 5✓a 7 to •,,k .st- '!), -97e 7d
-`VI Person authonzed by duty executed Power ofAtromey or by IC 0.1.1-12-0.7 / Date(month,day,year)
\\I Address of authorized person (number and street city,state,and ZIP axle)
"""��� The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.