HomeMy WebLinkAboutMortgage_Lanham (2) s. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.15---? FOR DEDUCTION FROM ASSESSED VALUATION
State Fonn 43709(R13/10-15)
�— Prescribed by Department of Local Government Finance
INSTRUCTIONS: • File Mark
Tong Dates:s:person or by matt F fi w" r
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 properly i
located on or before January 5 of the immediately succeeding calendar year. l❑ Runty Recorder
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 tweh each e(12)months before March 31 of ea year the deduction is sought 2018
lo
See reverse side for additional instructions and qualifications.
Applicant(owner or contract resbic8ans on reverse side) • .
\ e--nn L 4 I. AP %:; r
Wrig District Ivey number t legal � '(ll� Rem it'umb;C U?page mirirmbieY OR
CEIrefc31Cil ‘p-\.- - Cry- •-k- OC)1. Cq-- 0-AR / 8 8 / 7
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
astonspnt date,current year assessment date,current year date qf application �"+ �� fill legal or equitable owner?L O r Trl)f T_ ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse.indicate with whom
If nanre on record is different than that of applicant indicate below: Is the in question Annually Assessed
eal Property ❑ AnnuallyAssessed
r '�I. Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller .— 1 <— ` C-CL j
V- -9.A e rah Cur \ Un'1 •
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assgrree r or ein erS mrntga e
Address of assignee(number and street city,state;and L e . ��
•
Does applicant own property in any If yes,what county? What Taiping District? Has n
other Im rga county ❑Yes ❑No on �, J/�n��, �
A person is not entitled to this deduction unless the person has a balance on the person's mon C / /`mow/"
recorders office(including any home equity line of credit that is recorded in the county recordc ,✓
COUNTY AUDITOR
Deduction approved in the amount of /8 dB/2/n/ _
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 l contract buyer of the aforementioned property on date application is filed.
Sire(owner's fun name) 1 Date(month,day,year)
KUIofaltihanrr sh .
Fug resident address of applicant(num street y(y,state,an LP code)
1 (7, v Alrw ) hitt 1- '/0 fr1t k . - N7U2o
n authorized by duly enaad Power of Atforbey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet city state,and LP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.