HomeMy WebLinkAboutMortgage_Hix (3) ,�, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
e' 7, FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 43709(R13/10-15)
I`_ .i,l
�- Prescribed by Department of Local Government Finance �'
INSTRUCTIONS: .. File Mark
To be filed in person or by mail. JUN 1 O.: a.-•with: s•
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ Cou r• Auditor
located on or before January 5 of the immediately suooeeeding calendar year. • —i tiyt •unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the ••r
where the property is located during the twelve(12)months before March 31 of each year the dad/29064 apa .0 N-.% -
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see resticti ns on reverse side) .
Ton Dg gYtS /legal descnpuon -)• Retard number Page number
1�(1 1V,r1(_/� ab-1a oi -t02.- 000 ;.�; ;:�-.-on act\ 1esci4 .
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment dalu,crurent year date appf 1" legal or equitable Amer?
tS O Q ❑ Yes ❑ No
If re,what is his I her exact share of interest? If owned Bone other than spouse.indicate with whom
If name on record is different than that of applcaant,indicate below. I ethe P in question:Annually Assessed
eat
Property ❑ MnuallyAssessed
Mobile Home(IC 6-11-7)
Name of mortgagee or contract setler ` --I (1 L , _1 5 nvto v i 1 r•/ Lo a")
•
Address of mortgagee or contract seller(number and t dry,std and LP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet cry,state,and ZIP code)
Drawer O
Does applicant own property in any If yes,what county? What Taxing District? Hi I 9 y lion
other county ❑ or :/.(1 J
in Indiana? Yes ❑No or Card N O.
A person is not entitled to this deduction unless the person has a balance on the person's it county
recorders office(including any home equity line of credit that is recorded in the county recd , _._..__._____._. _.________...
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 coned and that the applicant is a resident of Indiana and
owner I contra buyer of the aforementioned property on date application is filed.
Signature foes •r Date(month,day,yea
.cf ..j rC a-/S- clot S�
Full resident dresJs� •( .�1.- and street,dty sta�y"and ZIP code)
`�Dt/� N A Sr f�(ylrt t'e7 v) 97470
Person autiforized by duly executed Paver of Altome/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 S10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNF I T J R ,
Name of applicant �. 1 Q`'�''�I L , , r Name of mortgagee or a selneKcA s e rD 7 1
Date filed(month,day,year)j'r�'nl V 1Y-'h1Amouml of ind ness \vI1,L]I 11.0^!� v\l`D. i� r
G - IS'- 1C R \ loo — R4 fis�.�p . v�•
Key number!legal description �l Q
()_I d\— l3�^�C�� o .201 —0\ V (ggnht COUNTY AUDITOR
Signature of County
;Jq�(y)\S�t1�w\�unMitecorger A./VC\ County/'j O n -date(month,day,year)