HomeMy WebLinkAboutMortgage_Wright ,<R , STATEMENT OF MORTGAGE OR CONTRACT INDEBTE�I Township Year
'f' , r, FOR DEDUCTION FROM ASSESSED VALUATION 1gpN �q
:_.'_.1.3, State Form 43709(R13/10-15)
•
"- Prescribed by Department of Local Government Finance
INSTRUCTIONS: JUN 0 4 2018 File Mark
To be filed in person or by mail. Form filed with:
FNng Dates: 1) Real Property-Must be completed and dated in the calendar year for which the ded..•:.. is .h
Must be filed orpostrnarked with the County Auditor or County Recorder of the•. 411 or iina.4?•-rtyis 7 County Auditor
located on or before January 5 of the immediately succeeding calendar yca{ �lv� ID County Recorder
2) Mobile I Manufactured Homes not assessed as Real Property:Must file tai rnyrm�tiVo/tif Zge
where the property is located during the twelve(12)months befom Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant( contract buyer-see restricbars on reverse )
CA -11 4 C> h�u�rnsn a ).c
=In Key number/legal description Record n`'`�' Paged` " `Q
nA e ail) 14-J -I S'304 no ? 7- -T Contact (((JJJ l p(( l
Assessed value of real property Mortgage I Contract indebtedness unpaid as of Mortgage/ indebtedness tedness unpaid as of Is the appr�m the sole
assessment date,wnem year assessment date,anent year date of application legal or equitable owner?
Z, Z CO ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
It name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
3t3eal Property 0 Annually Assessed
• '—' Mobile Hone(IC 6-11-7)
Name of itgage:or contract seller
Address of mo ,((J Scouted seller(number and street,city,state,and BP code)
Name of assignee or other owner or holder of mortgage ^ / (x��. - - - - - —
O I V
Address of assignee(number and street c i t y,state,and: Drawer NO
Does applicant own property in any If yes,what county I rn requested If yes,state amount of deduction
Card NO.
in county
Indiana? ❑yes 0 N 0 N
A person is not entitled to this deduction unless the, _.._..ct indebtedness that is recorded in the county
recorder's office(including any home equity line of c..- .,,rmwuec in me county recorder's otfica)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,yea)
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 . .-.-rty on date application is filed.
Signature( name Date(month,day,year)
F //,� G/ylza<�
Full r rut"name
- • (number- d sleet city,state,and ZIP code)
n authorized by duly executed Parer of Attorney or by IC 61.1-12-0.7 Date(month,thy,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.