HomeMy WebLinkAboutMortgage_Adamson (8) sue+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. "'k FOR DEDUCTION FROM ASSESSED VALUATION
'•, State Form 43709(R13/1O-15)
C -. ' Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed wtth:
Filing Dater 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is - ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county ❑ County Recorder
where the properly is located during the Melva(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
App4ranl(owrrerwaprraap buyer-Sm/�i�arn on.reJ�`'7�'+ M/� /�(� '1 "1
Taxing District l/ ��Ip i ..3 .V 3 H oO -lM/- tti). O OI t". Record nurn6ad /e�m
Assessed value of real property as of rOc)�O Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as'of OVIs the applicant the sole -
assessment data,current year assessment date,current year rice oLf application legal or equitable owner?
r7r � ID yes El No
If no,what is his I her exact share of interest? If owned with someone other than spouse,imitate with whom
If name on record is different than that of apprsant,indicate belay. /J Is the property in question:Annually Assessed
• L. Annua Hare ss 61.1-7)
Name of mortgagee or +contract seller .11,
Address of mortgagee or contract seller(number and street oily,state,and ZIP code) APR 17 2018
Name of assignee or other owner or holder of mortgag--
on inn sa/-)l c r r^' r
Address of assignee(number and streetcity,state,an /1niete INTYAUDITOR-pats r
Does applicant own property in any If yes,what coin L 7n �. guested If yes,state amount of deduction
other county ti (..L'/r' ❑No _
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless if /0- /3 05 ?debtedness that is recorded in the county
recorders office(including any home equity line c re 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
own /contract buyer of the aforementioned property on date application is filed.
S' re /r�1 fob name) Date trah,da,ye appficant(number and street,Full re n 'I .s 5 0 r `�c�. code) 4 76 3't
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12417 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.
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