HomeMy WebLinkAboutMortgage_Guinto sa STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township , Year
f _'- f
��:, FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
`— Presaibed by Department of Local Government Finance
INSTRUCTIONS: • File Mark
To be filed in person or by mail. Form filed with:
Filing Dates' 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
Must be hied or postmarked with the County Auditor or County Recorder of the county where the properly i ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. �i -.. .
I er
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the coun ; i [ i
where the property is located during the twelve(12)months before March 31 of each year the deduction is L ' • - .
See reverse side for additional instructions and qualifications.
• t(owveror contract buyer-see restrictions on reverse side) JUL 1 3 2018
ent&s S &,u,1 A0
Taxing District Key number/legal Record n , •-r Page
Q.nrctkDA . 2h- QZ- i -301 con . ltQ- 028 Zig 1 .. •1a-tcs
Assessed value of real property as of Mortgage/Contract indebtednkss unpaid as of Mortgage/Contract indebtednessdilMW fOffitttiViiiiiplic�at 6k'
assessment date,cement year assessment date,anent year date of 1 3411 regal or equitable owner?
co lIV ❑ Yes ❑ No
If no,what is his I her exact stare of interest? If owned with ne other tharlspouse,indicate with whom
If name on read is different than that of appfa-ant,indicate below: Is the property in question:Annually Assessed
yeReal Properly ❑ AnnuatyAssessed
Moble Hare(IC 6-1.1-7)
Name of mortgagee or contract seller r T ak .
Address of mortgagee or contract seller(number and sheet,city,state,and ZIP code) V\�'\ n
Nam GAM e of assignee or other owner or holder of mortgage ` ` 1 Vi•n US S
Address of assignee(number and street city,state,and ZIP code) ii, (R _ 7 SS
u�applicant own property in any If yes,what county? What Taxing District? diction
in Indiana? ❑Yes ❑NO Icnrem yeas. ..� ,...• .�.._
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 fine 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 I contract buyer of the aforementioned property on date application is filed.
Signature(owners full nom- Date(month,day,year)
X
--4111 "7—‘1—)g .
Full resident a•dress applicant��C�N(�number and sheet,city,state,,and ZIP code)
P 11`autorizeed by duly eexec:MP PoweofAttbmeyorornbyIC e1�24.7 nn -W-1-610 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. - - - - --