HomeMy WebLinkAboutMortgage_Altgilbers (2) ,pq STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
icr FOR DEDUCTION FROM ASSESSED VALUATION
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State FOm 43709(R73/10.1�
�- Prescribed by Department of Local Government Finance Ma IIII
INSTRUCTIONS: '. Fruit
To be filed in person or by mail.
-:with-
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought A pp
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properyRs 1 1 4041 County Auditor
boated on or before January 5 of the irnmediataly succeeding calendar year ❑ County Recorder
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the ••unty
where the property is located during the MvNe(12)months before Mardi 31 of each year the dad I. ,.,.., —
See mverse side for additronal instructions and qualifications. r yre [%iii
GlRcri i COUN1Y q
Applicant(owner or contract buyer-see restrictions onreversesideJ ) UDITOR
T 14 ) Key number/ I sdesuiptran//•K/•�J.// Record number Page raj
1/ ��'... re a6,- /d • / 7 - /0/ - Doy. ..35 - 0rxB fl
Assessed value of real property as of Mortgage I Contact 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?
el 98,� ❑ yes ❑ No
If no,what is his!her exact share of interest? If owned with someone other than spouse,indicate with whom
N name on record is different than that of applicant indicate below: Is the property in question:Annually Assessed
❑Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or con oot seller —
rt[jifp�" s
Address of mortgagee or contract seller(number and about fitly,state.and n
Name of assignee or other owner or holder of mortgage 1/e/� &iN___3 S-S-I K
Add of assignee(numb and street,city,sta and ZIP cede) 4- n 1 �/�„ - fyyJ
Ayer county awn property in any If yes,what county? Mat Taxing District? Has this properly far , EMP/
j Ci ion Indiana? ❑Yes ❑No currrenntyeaar?w I t//_l J/A person is not entitled to this deduction unless the person has a balance on the person's mortgage or a
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)
COUNTY AUDITOR V/ /;
Dedurbon approved in the amount of. V I I I ��yo�-/ C(/�n I
20 20 20 20 20 ` V 1�1� �/
Signature of County Auditor County - 1 '��� ”"r.�
•
I/We certify under the penalty of perjury that the above and foregoing information S true and coffer 02c 1 6 Y-
owner I contract buyer of the aforementioned property on date application is filed.
" \ Signature eta nt ) / Date(month,day,year)
1/ Fufl resident' tlr�ss of apprxant(number an. ,,�� ,slate.and ZIP code) I
r� .I 98•3 iii j v , 7rho cur) 3 7e70
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)mess of authorized person (number and store;city, ce
state,and ZIP de)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. .