Loading...
Mortgage_Wilkinson (2) �s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS couF 4 Tower fs Aj Year E`' FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R13/10-15) �-- Prescribed by Department of Local Government Finance JUNF INSTRUCTIONS: (Iv) ,�18 To 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 deduction is sought Must be filed orposbnarked with the County Auditor or County Recorder of the county where the prone rty (pr1 unty Auditor located on or before January 5 of the immediately succeeding calendar year. GIRSON C OU N7©A61OSt@ corder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county where 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. . )(owner or contra re ' on reverse side) kr // ''■ T District Key number description Record num Page tuber Oa, •-to C a6 -/y_/.9 , / oil- - coo. a- 1 S-oO ? I l 7 6 Assessed value of real p'opppy as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole assessment data, assessment ate rent y�r assessment d ,current year date of apOccriion legal or equitable owner? 10 6, / t? ID Yes El No If no,what is his I 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: Is the property in question:Annually Assessed ❑Real Property ❑ Annually Assessed Nbbae home(IC 6-1.1-7) Name of mortgagee or contract seller • n Address of mortgagee or contract seer(num and street city,sate,and ZIP code)de) Name of assignee or other owner or holder of mortgage Address of assignee(number and street,dry,state,and 2 Drawer NO. /�A\1 //��'+ Does applicant own property in any It yes,what count, •. '•••••. V•,,• en requested If yes,state amount of deduction other county in Indiana? ❑Yes 0 No ..... .. (es ❑No. county A is not entitled to this deduction unless th __ C�) tl 1�O. ract indebtedness that is recorded in the coup recorder's office(including any home equity line of Credit that is her,,,.,.__._ .. ,, It 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 l 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 I contract buyer of the aforementioned property on date application is filed. Signature - Date(month,day,year) ) �i a �l`f�7��� Fug - r a (number sheet dry:state,and LP code) P- en authorized by duly executed Power of Attorney or by IC 6-1.1-12-01 11 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.