HomeMy WebLinkAboutMortgage_Brown (27) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
0,- FOR DEDUCTION FROM ASSESSED VALUATION
-:',
r �'- State Form 43709(R13/10-15)
�- Prescribed by Department of Local Government Finance
INSTRUCTIONS: .. . File Mark
To be filed in person or by mail. Form sled 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.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county ❑ County Recorder
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.
App&ant(owner contract buyer-see on reverse side)
Chd Rs wA
T !gn�nce A number t-i vg --coo . 4Z. 0t2 . ($ X30$0
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contract indebtedn unpaid as of Is the applicant the sole
assessment date,and year assessment date,current year dare "��wry� ( legal or equ' amen?
? U01, • r LYxas 0 No
If no,what is his 1 her exact sham of interest? If arced vrgh Bone oiler than spouse,indicate with when V
If name on record is different than that of applicant,indicate belay. Is the property in question:Annually Assessed
❑Real Proce .J r Assessed '
n
one(IC 6-1.1-7)
Name of mortgagee ocontract seller �j ^� - J ,J 3:�•
Address of mortgagee or contract seller(number and street ray,state,and ZIP code) AUG 8 2018
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP ,
V (�� ;ON COUNTY AUDITOR
Does applicant own property in any If yes,what county? 1 2-0 ` " wasted If yes,state amount of deduction
o county ❑Yes ❑No Drawer NO...... 0 N
A person is not entitled to this deduction unless the pe. 08-° lebtedness that is recorded in the county
recorders office(including any home equity line of ore, Card NO. ..... .. ........... basis for the deduction.
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/contract buyer of the aforementioned property on date application is filed.
Signatu : - r . .e) Date(month,day,year)
L1.4 A . X Zot
F
ir
es- r -:..- of app.- (number- d street city,state,and ZIP code)
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street dry,slate,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. - -- - - -- -
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