HomeMy WebLinkAboutMortgage_Adams (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ir. FOR DEDUCTION FROM ASSESSED VALUATION
'- State Form 43709(R13110-15)
Presrnbed by Department of Local Government Finance
INSTRUCTIONS:
File Mark
lb be filed in person or by mail. Form filed with:
Filing Dater 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
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile I Manufactured Homes not assessed as Real Properly: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 deduction is sought
See reverse side for additional instructions and qualifications.
Appfoant owner a contract see'evictions �rse srdfi l
C/�1.1Ll►.t� 3 on-ii •
Taxindszn A Gi -�4'�^i 104- o° x :308 -Oo7 _ Record 20\$ I , 1-1
Assessed value of real property Mortgage I Convect i debtedness unpaid as of Mortgage/Contract indebtedness unpa'qq as of Is the applicant the sole
assessment date,current year assessment dad,wrest year date of p:7 legal or equ a owner?
� 0� • es ❑ No
If ro,what is his/her exact share of interest? If mimed with acne other indicate with whom
tf name on record is different than that of applicant,indicate below: Is the perty in question:Annually Assessed
p
• •PeItr ❑ Aflnualy Asse55ed
•
kbb�e home(lC 61.1-7)
Name of mortgagee or contact seller r {t...� , 3 e I FILED
Address of mortgagee or contact seller(number d street city,slate,and ZIP code) e �
Name of assignee or other owner or holder of mortgage nn II AUG G 6 2Q13
,.}z,SSICq._ M 1
Address of assignee(number and sheet city-state,and ZIP code) 'l, ASc - o vt2 j -N-O 5/3 - _/�/
Qnn�t (fin tJpr„ t�nITCR
�applicant own property in any If yes,what county? 1 (_'i-1a • CZ • A S O I g o U . b U If yes,Isle araurl dtdedocaon
in Indiana? ❑Yes 0 N r� b`? — �
1e ,
A person is not entitled to this deduction unless the person has 6 S-1- l Z !ss that is recorded in the county
recorder's office(including any home equity line of credit that is ir the deduction.
COUNTY AUDITOR
Deduction approved in the amount ot.
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.
(month,day,year)
lr 8 (. Jol
�(` I I 8
Tull resident address of applicant(number and street city_state,and ZIP code)
S
Person authorized by duly executed Paver of Attorney or by IC 6-1.1-12 r.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$10,000.