HomeMy WebLinkAboutMortgage_Perry (9) :r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year%_rota FOR DEDUCTION FROM ASSESSED VALUATION
...- ')'- State Form 43709(R13/10-15)
. :- Presa�bed by Department of Local Government Finance FILET)
File Mark
INSTRUCTIONS:
To . MAY 2 20-IL filed nib:
be filed in person or by mail.
Filing Dates' 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 • iii-rty is r ❑ aunty Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County qqyy��$�� 14... 171'C1I�' ❑ County Recorder
where the property is located during the twelve(12)months before March 31 of each year thew 7%7'. '.•+:, tY Ad TeR
See reverse side for additional instructions and qualifications.
Appea owner or contract buyer-see on reverse side)
�/; Cfi /
Taxin• .e Key rmurnba!legal • - Record number Page number
`� 02(0 , id,_ 07 - 3o a - oo /- 93g _ o .tsj Jo( 0 e r
Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage/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?
If no,what is his/her exact share of interest? 'If owned with someone other b4an spouse,O ❑ Yes ❑ No,indicate with whom
tf name on record's deferent than that of applicant,indicate below Is tM in question:Annually Assessed
_ eel Property ❑ Cpd-. 1-7)
Name of mortgagee or contract seller` //
/y 1.1/7 1
Address of mortgagee or contact seller(number city,state,and ZIP code) �n I eV J O (,
Name of assignee r other owner or holder of mortgage �t•il\\'Cl 1SO'••••'(Q�' /1
Address of assignee(number and street city,state,and ZIP code) 1J • �!• •f//•1'''
Card IN 0- ••....••
Does applicant own properly in any If yes,what county? what Taxing District? .Has _ro,state amount of deduction
other county , pr.
in Indiana? Yes ❑No turret ..,. roes. ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of aedit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction 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 aforementioned property on date application is filed.
XS' /ire borers{/uyg e) Date(month,day,year)
JF resident as ofa lcant(nut/ an a} sae,and ZIP code)
l� 2 3 s /it t ipp _ iil 417&7o
91 erson authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Data(month,day,year)
Address of authorized person (number and sleet 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.