HomeMy WebLinkAboutMortgage_Bammer & Thrall Inc x STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-= ;� FOR DEDUCTION FROM ASSESSED VALUATION
}'`t State Form 43709(R13/10-15)
<-• Prescnbed by Department of Local Government Finance
INSTRUCTIONS: • F
To be filed in person or by mail. rm fi
Filing Dates: 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought JJJ�SSSJJJJ������rrr
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. A rD 1200&VMecerder
2) Mobile/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.
Applicant(owner or contras buyer-see restrictions on reverse stile) 1 • �f
r$a l\R\Cr c -Z�c-c ,,U �ti C - SSEB3� COUNT`( AUDITOR
T D' Key number/legal description / Record number Page number
:� -A400. Ok —b-k— -3cP- � gyp. O,2
Assessed rake of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date,curard year assessment date,current year date of application legal or equita es?5 bl iS0 0 es ❑ No
If no what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is("Efferent than that of applicant,indicate below: 1 Is the property in question Annually Assessed
❑Real Property ❑ Annua yyAsessed
— - — _ .Mobile Nome(IC 6-1.1-7)
Nameof •... or contract seller
—
Address of mortgagee or••it--seller(nu and street sty,state,and ZIP code) �/'\1 C
Drawer NO lJ
Name of assignee or other owner or holder of mortgage
-
Card NO. 3°31° —
Address of assignee(number and street city,state,and ZIP code)
Does applicant awl property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state arotiM of deduction
oia'anna? ❑Yes 0 N currrent year? ❑Yes 0 No
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 line 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 CountyAuditor County • Date(month,day,year)
I/ correct 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
• 'Sr I . • 1 er of the aforementioned property on date application is filed.
j•.•. hull e) Date(month,day,year)
.y / /
r-17 -•w-.-, of applicant(number and street city,slate,and L e) y,
E.c N . rQ' � L.r``) . le Q c ,-)I ) O O LQ
Person authorized by duty executed Power of Attorney or by IC 61.1-12-0.7 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$10,000.