HomeMy WebLinkAboutMortgage_Boop tSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.. FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: eporaerr�f
To be filed in person or by mail. MAY 1 O tutu with:
Filing Dates: 1) Rea Property.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the CountyAudiitor or County Recorder of the county where the properly is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. f,M-ra... Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the •• r .. „Elliott
where the property is located during the twehe(12)months before March 31 of each year the dedr .LINTY AUDITOR
See reverse side for additional instructions and quafdreations.
Applicant(owner d buyer-see msaiclions on nerse side)
I/.. -C )
Taring District tuber l legal desert O Record r Page number
(0 - 13-23 - /ofd- OD . - (90 i �� � a
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,cement year der legal or equitable owner?
VV'�) ❑ Yes ❑ No
If no,what is his/her exact share of interest? If wined w I%other than'prursn,indicate wi h 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 6-1.1-7)
Name of mortgagee or contract seller (7 i, _ 1�7+n���,�� Q
Address of mortgagee or contract%Mar(number and street cry,smote;and P code�.L ) `�/lTl
Name of assignee or other owner or holder of r '---
Address of assignee(number and street city,s r
Drawer NO.........
(1
Does applicant own property in any If yes.vd 1 ( ion been requested If yes,state amount of deduction
'nnInd'aana? ❑yes ❑No Card NO Ill yes- ID No
A person is not entitled to this deduction un =tract indebtedness that is recorded in the county
recorder's office including any home equity ._._ ...,..,•.y 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
ppww//pper I contract buyer of the aforementioned property on date application is filed.
9pgerure(era name) Date(month,day,year)
ly\A a � T �� 5-17-!
Full r i address d Sant(number and street city,state,a ZIP code)
_ / 51cC, S 45 a E' ® .�tA 4 2(0(00
Person authorized by duly executed Power of Attorney or by IC 6-1.1-1 Date(month,day,year)
Address of authorized person (number and street city state,and ZIP code)
nennIties for perjury can include imprisonment up to two and a half years and a fine not to exceed 410,000.