HomeMy WebLinkAboutMortgage_Curry STATEMENT OF MORTGAGE OR CONTRACT INDEBTE
•
,f rJ, FOR DEDUCTION FROM ASSESSED VALUATION Township Year
State Fonn 43709(R13/10-15)
�-- Presorted by Department of Local GovemmeM France MAY j j 2018
INSTRUCTIONS: • File Mark
lb be filed in person or by mail. Fonn filed with:
Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the•-•1.w;.r '--,-,rt : ,.y,
Must be filed or postmarked with the County Auditor or County Recorder r6•. ••4 - .#:'/rt- 8 R ' `eunty Auditor•located on or before January 5 of the immediately succeeding calendar year Y U /ITT❑```_C"""ounty Recorder
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
when the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner buyer reverse side)
T " g D' • Key number/legal d��2n Record number Page number
Z ei-/ 9-)g • 300(2 /95;i0a6 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,aarerd year assessment date,cement year date of application legal or equitable owner?
44000 ❑ Yes ❑ No
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 ddferent than that of apprant,indicate below-. is the property in question:Annually Assessed
)-Real Property ❑ Annually Assessed
Montle Home(IC 6-1.1-7)
Name of mq�g v contract seller
J
Address of�'mortgagee or contract seller(number and sheet city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city state,and ZIP code) -
Does applicant own property in any If yes,what county? Mat Taxing District? Has this deduction been requested If yes,state amount of deduction
other county ��R @Inda ❑Yes ❑No on yea ❑Yes• ❑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 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,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.
S- natu ( fug name) Date(month,day,year)
a re Oet (-writ/ .
Full resider address of app" t(nu and sheet.city,stale.and ZIP code)
706 /y
Person authorized executed Power of Attorney or by IC 6-1.1-12-0.7 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$10,000. -t _