HomeMy WebLinkAboutMortgage_Rhoderick STATEMENT MOR GAGE O CONTRACT INDEBTEDNESS Coun Township Year
'. �, FOR DEDUC N FRO ED VALUATION
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.� State Fotm 43709(R13110-15)
Presalbed by Department of Local Government Finance cm.
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INSTRUCTIONS: -- - i li
' ` File
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To be filed in person or by mail. Form rtfal.4ith:
Filing Dates 1) Real Properly.Must be completed and dated hi 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 proper F P 2 Q !' 5County Audito
located on or before January 5 of the immediately succeeding calendar year. U Coun r
2) Mobile IManufactured 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 Mardi 31 of each year the deduction is 5b t
See reverse side for additional instructions and quar::cations. ,•.
tOwner_ atonedbuyer-seeresettionson feverseside) cl3C0irivuf\IYAUD)TnR
Taxing District
legal
Page number
A cY (INd Ilo number ►\A r0- -ao.3-c00c •x313 CO17 247 4-C
Assessed value of real p,op a of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,anal year date of 10 Q legal orequitab:e owner?pJ ', ❑ 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 app1ican1 indicate below. Is the in question:Annually Ac nsv+d
_. Property 0 MnuailyAssessed
Mobile Home(IC 6-1.1-7)
Name of moft, ee or con
• 1 N\Dtratnk{ - L LC Na A 4-1D ifh a d e-r r LA,
Address of mortgagee or conbac,seller(number and street city,state,and ZIP code) Je n niter-ter- h u d e t i c.A--
Name of assignee or other owner or holder of mortgage Address of assignee(number and street city,state,and ZIP code) 1 v 4 ✓71
05 r
Does applicant own property in any It yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for .
in Indiana? ❑Yes ❑No current year? ❑Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the persons mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity tine of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deducion approved in fire amount of
20 20 20 20 20 20_ 20
Signature of County Auditor County - Date(month,day,year)
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I I We certify under the penalty of perjury that the above and foregoing informations 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.
Stis.r,�[apure(owners fuename) t� Date
4ontft day,year)
{bq,l. . C�rsx• \ \Ncr1Lx x r.1,�J 1 - Can -c6 .
F resit Maddress ficant(number and street,city,state,and ZIP code]
� -, . Vi ai ��-, l ' �klt, k& Q , uh1p(o
P n authorized by duly executed Power of Adomey w by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for penury can include imprisonment up to two and a half years and a fine not to exceed$10,000.