HomeMy WebLinkAboutMortgage_Seaton STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
:'t'' - FOR DEDUCTION FROM ASSESSED VALUAT1O���NNN111
State Form 43709(R13/10-15)
Prescribed by Department of Local Government France
INSTRUCTIONS: 1 6 2018 _ Fde Mark
To be filed in person or by mail. APR Form filed with:
Filing Dates 1) Real Properly Must be completed and dated in the calendar year for which the deduction is y.
Must be filed or postmarked with the CountyAuditor or County Recorder of I :cou»ty,r••-.'the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar ye. [ , . �i��r 17n R ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file : - u Xu f tie county
where the property is located during the twelve(12)months before A paSC :7. year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer- oo reverse side)
misbict Key• -- s Pr,�> number -7
T 2 t i S _509 acs 7 ea 9 Record/$ anumber
/ �
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage t Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year data of application legal or equitable owner?
, 9a7oy ❑ Yes 0 N
If no,what is his/her exact share of interest? If owned with someone other than spouse indicate with whom
If name on record is different than that of applicant,indicate below: Is the properly in question:Annually Assessed
OPeal Property
Annually Assessed
• Mobile flaw(IC 6-1.1-7)
Name of mortgagee or contract seller _
- —Address of nortgagee or contract seller(number and street city state,and ZIP code)
SCM 7D J r
Name of assignee or other owner or holder of mortgage 5/1 ER-r
Address of assignee(number and street it state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? H t
other county , /q07,
in Indiana? Yes ❑No '1 Cr r
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness mar us rcw............. unty
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,yea)
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.
Signature((owners full nam Date(month,day,year)
x2- tki 6-� -- _ -/
Full resident address a I street,city,state,and L 5 76 3 9
Person authorized by duly executed Powe of Attorney or by IC 6-11-12-0.7 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 S10,000.