HomeMy WebLinkAboutMortgage_Cueto . , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County I Township Year
FOR DEDUCTION FROM ASSESSED VALUATION IL
�'- State Form 43709(R131 70.15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: _MAY 7 2018 a Mark
To be filed in person or by mail. For1n filed :
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or posbnadced with the County Auditor or County Recorder of the county where th= .perry' • County Auditor
located on or before January 5 of the immediately succeeding calendar year. !fir•!
2) Mobile/Manufactured Homes not assessed as Real Pmperty Must file with the Cour(gf;y". . : .I.,'Ir ❑ County Recorder
where the properly is located during the twelve(12)months before March 31 of each year the.'.!►. �? �' .:•UD TO R
See reverse side for additional instructions and qualifications.
Applicant(owner c4 restrictions onpreverse�/� 7
Taring District 2 /O legal d1 _( 1 O i . o°.D . ? -7 3 _O ;-�C Ono/8 Page number
Assessed value d• c
assesm t date,, real property year rig as of assessment Mortgage/Comma rent indebtedness year unpaid as of Mortgage/Contract indebtedness unpaid as of Is the or applicant
equitable e the sner
assessment date,aurerd year assesunsm date,current year date of application legal a equitable owneR
oeSOaa ❑ yes ❑ No
If no.what is his l 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: �p�`/� R n
Name of mortgagee / 00 I V — zj f 7 1-7)
ng�ea a<ooniact seller !<f �-- 6 1 —
s
Address of mortgagee or contact seller(number and street city,state,and ZIP code)
4a , 000 . °°— —
Name of assignee or other owner or holder of mortgage /
Adtl� of assignee(number and street, % ,state,and ZIP a ( 3 / Ff 4 J s+Qd f
Does applicant if property in any It yes,what county? What Taxing District? Ha !^+Cj f� _ 4
other county on \J �,�L.1!j
in Indiana? ❑Yes ❑No an
A person is not entitled to this deduction unless the person has a balance on the person's m y
recorder's office(including any home equity line of credit that is recorded in the county reoor 1 \I 101 n u t P
COUNTY AUDITOR
Deduction approved in the amount of C U e +'0 —
20 20 20 20 20_ C./ 1J 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 f contract buyer of the aforementioned property on date application is filed.
re(owner's IW e) cA_� (� Date(month.day,year)
x Fri • addrex (num �A^-street�tcer,sstate nd ZIP code)
I3' n �L u g76% t
Person authorized by duly executed Power of Attorney or by IC 5-1.1-12-0.7 I (month, y year)
Address of authorized person (number and sheet city state,and ZIP code)
The penalties for perjury can include imprisonment up to My and a half years and a fine not to exceed$10,000.