HomeMy WebLinkAboutMortgage_Scott (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C Township Year
FOR DEDUCTION FROM ASSESSED VALUATION F
,= State Form 43709(R13/10-15) IL h
�- Presalbed by Department of Local Government Finance
INSTRUCTIONS: PPR 11 2018 File Mark
•To be filed in person or by mail. Form filed with;
Filing Dates: 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought ,
Must be filed or posbnadred with the County Auditor or County Recorder of the county will: the r���;,iii; Old •unty Auditor
located on or before January 5 of the immediately succeeding calendar year. WWII- County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Cqg• bl��oomy
where the property is located during the hvelve(12)months before March 31 of eabil TM- deduction is sought
See reverse side for additional instructions and qualifications.
Apptiranl(olwrer or contract� A 7 on inverse sde>S�_ J J/ -
T _ (/ •{i �1/numbmber t legal description Record number Page number
aI0-/a -o7- ao3coo3 /oR ,Jat 7i3" 35‘ z
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year data of application
tion legal or equitable owner?
/c p td OOO ❑ yes ❑ No
If no.what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name at record is different than that of appliant indicate below. tr5 the_p_ro�perty in question:Annually Assessed
)tUeaI Property ❑ Annually Assessed
Mobile Hone(IC 6-1.1-7)
Name of nnrtgages or contract seller
N8
Address of mortgagee or contract seller(number and street city,state,and ZIP code) —-
Name of assignee or other owner or holder of mortgage orb 18 -
Drawer NO
Address of assignee(number and street city state,and ZIP code)
Does applicant own property in any If yes,what county? what Taxing District? Card N O. �� ion
other county , -
in Indiana? yes ❑No or
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or corm a.' -.._._.._.___.- aunty
recorder's office(including any home equity line of credit that is recorded in the county recorder's 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!contract buyer of the aforementioned property on date application is filed.
S' (owners frail na e) Date(mu,th,day,)ear)ih_
rag resident address oof applicant(nummbbe-rr and street city,state, LP ,r �e) _
Person authorized by duly executed Power o�ey or IC 6-1.1-12-0.7 �� 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. .