HomeMy WebLinkAboutMortgage_Douglas (10) cur STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
` ° FOR DEDUCTION FROM ASSESSED VALUATION �r ^�
- State Form 43709(R19/10-15) F li}� ]' �t t
Prescribed by Department of Local Government Finance n ,„J +��
INSTRUCTIONS: ._ •..._ File Mark
To be filed in person or by mail AUG 3 0 2018 filedwi0:
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 Courtly Recorder of the county re the properly is County Auditor
located on or before January 5 of the immediatey succeeding calendar year. /( - County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Cou ,Au .the ty
where the property is located during the twelve(12)months before March 31 of dh7 ;he dedldioWissoWltO k
See reverse rya
instructions enthJk
Applicant(own l ¢act seem ,OO/llnumber/leal n r Page number
fl-act -/ /9aOFF I\ °" • oir� ac�
value of real property as Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid of Is the nt the sole
assessment date,current year assessment
date of application legal or equitalge owner?
❑ Yes ❑ 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 different than that of applicant indicate below. Is the property in question:Annually Assessed
❑Real Property 0 AnnuallyAssessed
Mobile Horne(IC 6-1.1-7)
Name of mortgagee or contact seller
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Address of mortgagee or contract seller(number and street,city, te,and ZIP cod
Name of assignee or other owner or holder of mortgage UUU
ao ( 8 - 33L0
Mat Taxing District? Has this deduction been requested If yes,state amount of deduction
Drawer NO on
year?operty for Yes ❑No
/ ' ' ' ' as a balance on the person's mortgage or contract indebtedness that is recorded in the county
r. _ is recorded in the county recorder's office)that is the basis for the deduction.
Card NO. COUNTY AUDITOR
I
20 20 20_ 20 20 20 20
Signature n �AteditOr�� ��, County Date(Jry�) �Y.y/e��/��
V ll—�
I/We ce rider the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
,$ignature(owners ruff name) Q Date(month,day,year)
Y\ r
resid dress of applicant(number and street,dry, ,and ZIP code)
275 ci 5 3a5— CL2 '6ri 6 -r14 Sn 'i744P
Person authorized by duly executed Power of Attorney or by IC 6-l.1-12-0.7 Date(month,day.year)
Address of authorized person (number and sheet 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 410,000.