HomeMy WebLinkAboutMortgage_Fields (2) ;> STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou ,.� .yv sh'• ear
to) FOR DEDUCTION FROM ASSESSED VALUATION FI ,�State Form 43709 R13/10-15 ; I F
Resabed by Department of Local Government Finance - � - -.�- • '
INSTRUCTIONS: APR 11 2018 ` ' I r ,
To be filed in person or by mail. (lea
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Filing Dates' 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought •!�a K 1
Must be filed or with the County Auditor or County Recorder of r postmarked rtfy ty /JJ county e -,. : yn.-rtyfs I. , ' •..vI" 'r• or
located on or before January 5 of the immediately succeeding calendar ye.7� ve -he SIR �� - r -
2) Mobile/Manufactured Homes not assessed as Real Properly:Mug ••:•yr ) - • ikI •:-• of th » N C P : • •l1 tr)ri:1--
where the property islocatedduring the twelve(12)matths before Mardi Iof:�r ' 'Wagtails seseit BSONCOUNTYAUDITOi
See reverse side for additional instructions and qualifications.cations.
Applicant(owner or contract -see restrictions on reverse side)
T-.t • *idiot. number/legal description Record number Page number
V; ► aL -a-3- ft - can - oo .5 `l, - Na.4 ab1 a-1-7
••w_>.valued real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedn unpaid as of Is the applicant the sole
date,aarerd year assessment date,current year rate of appfration legal or equhabte owner?
AL► 6, g DO Yes ❑ No
If no,what is his/her exact sham of interest? ) tf owned with someone other than spouse,mdxate with whore
If name on record is different than that of applicant,indicate below s property in question:Annually Assessed
• Property ❑ Mobile yAssessed'
��(��� ''tom ,(� ( �/�1 Mobile Home(IC&1.1-7)
Name
v"c�l J seller Sr0 r0 L.L.P--ta_}L _
Address of mortgagee���y seder(number and street rte,state,and ZIP code`- . • I
Name of assignee or other owner or holder of mortgage t\4Y-O T- I t`e. 4 S t ),r (\
€'- t (A -E a ki o.A30 s
Address of assignee(number and street city,state,and ZIP code) ca e. c -
1(--.., `I
Does applicant own property in an If yes,what county.? What Taxing a4 Li 700.oc�to amount of deduction
other county --Oy �o l g — a�� I
in Indiana? ❑Yes 17No 0
A person is not entitled to this deduction unless the person has a balano \- l- la s recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recoruc,....,...__, duction.
COUNTY AUDITOR
Deduction approved in the amount of.
20 20 20 20 20 20 20
Signature of County Auditor County • Date(month,day,year)
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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( , s u04 n,. Dale(month,day,year)
Full resident address of app (num and city,state,and ZIP e)
1579 1. 4.-c umn e 4/gkOf add i/`) t/7437
P on authorized by duly executed Power of Atto or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.