HomeMy WebLinkAboutMortgage_Loving-Wilkerson a-' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
#' FOR DEDUCTION FROM ASSESSED VALUATION
'- 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 filed with:
Filing Oates 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. 0 County Recorder
2) MobIIe/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twehe(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and quafificafions.
Apprxant(owner or contact buyer-see rests on reverse side) I
\? rn s Imcr&ia. nil eo LO%/S'(r\r5 - �A?t \�CS'SOn .
T Duet Key number/legal description Record nurnbi,5 Page number
tN( eIren alO- tg - 01 - D 003. C Cag 36a
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the
asmc<me t date,amend year assessment date,anent year dasof application ta legal or,equitable owner?t I cooa---) Eris ❑ No
If no,what is his/her exact share of interest? If owned with someone otheir than spouse,indicate with whom
If name on record is different than that of applicant,indicate belowt Is the property in question Annually Assessed
0 Real Property ❑ AnnuallyAssessed
• Mobile Home(IC 6-1.1-7)
Nemec/mortgagee or contract tier T
BA)dcr\ 0 I I t e I P n ( 6 1N t R rt cd " r .. ��M--t--C� .
Address of mortgageeC,,h�i
or contact seller(number and en
P /a s1 6-fro .
Name of assignee or other owner or holder of mortgage
°to• I 30 3 FILED
of assignee(number and sheet oily,state,and 2
�(,�AN�u:;le fen-c Her: T/Ca- ,
Does applicant own property in any If yes,what county _ __ .,..,.y.nsmcr/ Has this deduction been requested If yes,state amount of deduction
other
❑Yes ❑No I Iairrrent year? ❑Yes El No SEP 24 2018
A person is not entitled to this deduction unless the,person has a balance on the person's mortgage or conbst 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 fo/p a dedu ' n
COUNTY AUDITORGifitertrettlictrrAttarr
_N-I
Deduction approved in the amount of
20 20_ 20 20 20 20 20
Signature of County Auditor County - Date(month,day,year)
I 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.
S" re(owner's full name) Date(month,day,year)
aonco
resident address of applicant(number
atatu,and 2l code)
D/7 � / /- sf- ?^:lie c icn , Z/ Y7(76
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,stale,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.