HomeMy WebLinkAboutMortgage_Alden STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
trlist„,;- t:_ FOR DEDUCTION FROM ASSESSED VALUATION
}'E State Fomi 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be fled 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 filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
boated on or before January 5 of the immediately succeeding calendar year. ❑ County 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 twelve(12)months before March 31 of each year the
See reverse side for additional instructions and quafrfn.dfiuns.
Appl" t eerpy or con see re on Tel ) J
T v\ �� description RedV1°u:�.s. 201 enumber
Jo ,s°11 . 2)-l8 -- 36 -Zoo -00 ;-t -0R3 . 7 &!
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/ .. .. indebtedness un•--'..as of ,U the ,.�.-.. • e�
assessment date,current year assessment date,current year date of a..ration r T .;r: r -•e owner?
• �. . O c' p -n.:- Pry' _ . ❑ No
0 no,what is his/her exact share of interest? If owned with soul:.ne other I - spouse,indi ate with whom +
If name on record is afferent than that of applicant indicate below. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Horne(IC 6-1.1-7)
Name of mortgagee or contract seller `-C� f, • ' 1 ' � Jt s+ ` r( .
Address of mortgagee or contract seller(numbE�3rd s6Ae7, 4 te,and ZIP code) r� �I-}Tt `J^ t�—y�l^y_/fL(�
- -
Name of assignee or other owner or holder of mortgage (:s y-. A■ 1,,Q,y� °k C3v-\�a��
L R1r.ev` A-0 Ck°-.\°5Va * 5�A.c -
Address of assignee(number and street city stale,and ZIP code) Z 1 L
Does applicant own property in any If yes,what county? What Taxing District? Has thi
other county rn on pro(
'6 Tv� b C Q.
in Indiana? Yes ❑No current
A person is not entitled to this deduction unless the person has a balance on the person's mortg Lo--1- 1g y
recorder's office(including any home equity line of credit that is recorded in the county recordera Wnuy a,ak to um kraut.,
COUNTY AUDITOR
Deduction approved in the amount of
20 _-20 20 _ 20_ 20_ 20 20
Signature of County Auditor County - Data(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/contract buyer of the aforementioned property on date application is filed.
XSignatr ( full name) Date ,day,year)
C.--- �� X 73/ l8
Fun resident address of a/pp�fxan (n and street city,state.and-ZIP code)
/
J( /O/d3 5 OG,U/ //-DJs,-„s, //4aI5lajJ zt'AJ `/7639
rson authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet city,state,and ZIP code)
The penalties for cerium can include imprisonment up to!wv and a half years and a fine not to exceed S10,000.