HomeMy WebLinkAboutMortgage_Donohoo � � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
kr- - „ FOR DEDUCTION FROM ASSESSED VALUATION
State Fan 43709(R13/10-15)
�– Resalbed by Department of Local Government Finance Mi:INSTRUCTIONS: - _ . F Zlif
To be filed in person or by mail. Form filed with:
Flung Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought 1^AA
Must be filed orposfmarked with the County Auditor or County Recorder of the county where the pmperry aR 2 i an$County Auditor
located on or before January 5 of the immediately succeeding calendar year
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the -• my County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction 4 i Ai --_/ fir
See reverse side for additional instructions and qualifications. C I BSOPI COUNTY AUDITOR
Appbcant( contract -see 'ns on verse side) !'�
� ANA
Taxing District number li .-� - 203 -003. 3oa - Record aai number Page number
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole •
assessment date,amen year assessment date,arrnent year date of appfip'uon legal or equitable owneR
(O 111 0 0 0 ❑ Yes ❑ No
If no,what is his/her exact share of biblical? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate belay. Is the property in question:Annually Assessed
❑Real Property ❑ AnnualyAssessed
Mobile Hone(IC 6r1.1-7)
Name of mortgagee or contract salter (^ A /,� ^ �, (� n _
ALatAddress of mortgagee or contract setter(number and street .and ZIP ' �^e))iod __ 1/L/VT () 1C�•(�LCACILIYI
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,sate,and ZIP code) (�-- - —
Doer county applicant own property in any If yes,what county? What Taxing District? 'Has p rt UV'c�y yA _ - —
in Indiana? ❑Yes ❑No current ye 1t--� 'r_
A person is not entitled to this deduction unless the person has a balance on the person's mortgag �Q
recorder's office(including any home equity line of credit that is recorded in the county recorders r � °.^-4 a-bC,,,z_
COUNTY AUDITOR L(' (DO O . OD
Deduction approved in the amount of:
^o■Di ?— i a741 —
20_ 20 20_ 20 20
I _
Signature of County Auditor County - Date(month,day,I .
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 I contract buyer of the aforementioned property on date application is filed. •
Signature(owner's hill name) Date(month,day,year)
•
Full resident 3Oil applicant( ben and street city,sate.and LP p /1 nG it)
Person authorized by duly Cexecuted Power of Anome/or by I .1-12-0.7 /�(l/-(, 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.
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