HomeMy WebLinkAboutMortgage_Hughes (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'_`� FOR DEDUCTION FROM ASSESSED VALUATION
Cr; . State Fortn 43709(R13110-15)
�- - Presatbed by Department of Local Government Finance
INSTRUCTIONS: _ File Mark
To be filed in person or by mail. Form filed 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 postmadred with the County Auditor or County Recorder of the county where the properly is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
when the properly 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.
1(owner nr rrm.'rarf hrvw-cap rp_sbirlions on reverse slde)
tSlo '- c4- 1_� r,c 1 cikeS .
reang ra M-T-._ . Record number Page number
Q4 lekna � 'Ll alQ- 13-13- `-1ea- Cool - aFs�j csJf aol g 3g0q
Assessed value of real prop- as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment data,current year assessment date,current year date of application legal legal or equitable owner?4P i n t C CO juoar s ❑ No
0 no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that at apph¢nt,indicate below. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee contact seller g��
1- DSpn • ►n(1 4r �. 'rl FILED
Address of mortgagee or contact seller(number and sheet state,and ZIP code)Name of assignee or other owner or holder of mortgage SE? 2 5 2018
Address of assignee(number and street city;state,and ZIP code)
y�pUhtTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been i yas,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 person's motgatf
recorder's office including any home equity line of credit that is recorded in the courtly recorder's ^� (^_
Deduction approved in the amount o(: COUNTY AUDITOR Drawer NO /�/ (J8
•
20 20 20 20 20 Card NO.•
•
3/05
Signature of County Auditor County • —
I/V✓e 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.
Signature(ownersnne rub name) �1�'•� 1 -y•- Date(month,day,year)
Ful resident arc dressbi applicant(number soeet ray state,and ZIP EA ) �,,1-4/ (J .
Person authorized by duly executed kidney or IC&.1-k 3 j C [ ' . Lk Dee-(�'oO r)
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 S10,000.