HomeMy WebLinkAboutMortgage_Tredgold STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
'r '=vim FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13110-15)
Prescribed by Department of Local Government Finance • i
INSTRUCTIONS: - _ . �� .y.
To be filed in person or by mail Form filed with:
Fiffng Dates 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought iI,s,g�v ' ,}i,
Must be filed or postmarked with the County Auditor or County Recorder of the county where the pmpary is •ur i) County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2
0) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the to unty County Recorder
where the property is located during the Me/ve(12)months before March 31 of each year the did -v'.. 'i 4 }fFii
See mverse side for additional instructions and qualifications.
App tit owner orc - '-on reverse side)
CIO ON COUNTY el InIThR
T Dit Key number/legal.- Record numbe
/'�nrutirr� 4.2 to –�.? /�,- 30 a _ o oil . //D - o-�� Pagi!vj p�ra
value of seal property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as df Is the applicant the sole
assessment date,=Tent year assessment date,current year data of application legal or equitable owner?
l36? 0 6,
Dyes 0 N
If no,what is his/her exact share of interest? 'If owned with someone al(ier than spouse,indicate with whom
If name on record is different than that of applicant indicate below: Is the property in question:Annually Assessed
❑Real Property ❑ Annually Assessed
Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller
‘.21-1
rC/. �.
Address of mortgagee or contract setter(number a street city state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet,dry,state,and Li
Does applicant own property in any If yes,what county? �O �/ n requested If yes,state amount ofdeducrim
In
other Indiana? ❑Yes ID No lxV is No
A person is not entitled to this deduction unless the I Drawer at indebtedness that is recorded in the county
recorders office(including any home equity line of c FWD-
Deduction the basis for the deduction._
Card NO.
approved in the amount ot.
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 afore lonnod p rty on date application is filed.
X Signature(. n..e) Date(month,day,year)
•
/ si .and nn ur/'Y °f�
. Full r–/d ., -pp� '(nuL e/ w t 76, 7O •
Person• >• by executed Power of mey or by IC 6-1.1-1 -0.7 `•C///-"''/ 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.