HomeMy WebLinkAboutMortgage_Caniff (5)r
� a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
elr FOR DEDUCTION FROM ASSESSED VALUATION .
State Form 43709(R13/10-15) t on a nv All'Ito G NOSS IE)
Presorbed by Department of Local Government Finance
INSTRUCTIONS:
Filgark
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$[Q?] .1 1
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is ❑ County Auditor
located on or be fore January 5 of the immediately succeeding calendar year. unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Count'Au.';AM?? . co!
where the property is located during the twelve(12)months before March 31 of each year the.r .p.. 'nigh
See reverse side additional instructions quafificabons.
Applicant(owtrpior tract re roe side)
n It
l/ Kef mhmberdescdptiorh Record number Page number
�`^)�{V.//�� o -/OH) & {a (,3 -Oa 7 ;o � 31597
A, v-I value of real pimp as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date,current ed assessment da(gprQepl y�t� date of application legal or equitable owner?
�//�!/J"l/.Jr' ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
t name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
El Real Property ❑ AnnuallyAssessed
v1 j Mobile Home(IC G1.1-7)
Name of mortgagee or contact seller
Address of mortgagee or contact seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet aay,state,and ZIP code)
Does applicant own property in any_i If yes,what county? I What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county — on property for
in Indiana? ❑Ye: - current year? ❑Yes ❑No
A person is not entitle no��I, person's mortgage or contract indebtedness that is recorded in the county
recorder's office mdr • off/ (JY owii recorder's office)that is the basis for the deduction.
Drawer NO
Deduction approved in 2 ^ q
Card NO. .... (/J / 20 20 20 20 w/p(�� /yz re ry 'Il Cratnty Date(m/V Oat'/ arta2
/We certify under thepenalty of perjury t t ei ve nd foregoing information' true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementio a on date application is filed.
5iagnatie4o,upamcaAartfkl- � yn/ (J//;/�( /, Date(mgrd/l,day/yeah„-�rof\ za//M irI IF(,Ilipej,
ndIPcoa) AJ / l ! V7DlOt/(lilyPerson authorized by duty executed Power of Ati r�or e-1.1-12-0.7 / Date(month,day,year)
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$10,000.