HomeMy WebLinkAboutMortgage_Perkins (4) } STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
t '^ State Fonn 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INS7RUCAONS: .. File Mark
To be filed in person or by mail. Farm filed with:
Fffing Dates: 1) Real Properly 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 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
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and quafdications.
Appfxxnt�xner contract buyer-.see on reverse side) n .
RR�J__ aT_ �Key _Woo, L. lr � u�m�(
T �n�rict ` a.-06 -3u9,-0pS3y1 - 023 -escription 2On' (J Page
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment data,current year assessment date,current year date of CP legal itable owner?
If no,what is his/her exact sham of interest? If owned with son an sp us indicate with whom Yes ❑ No
if name on record is afferent than that of applicant,indicate below Is the property in question:Annually Assessed
0 Real Property 0 AnnuallyAecnsed
Mobile Sim(IC 6-1.1-7)
m Name of mortgagee orntract Seger O1& �Qnai . eT,K]_f k FILED
mortgagee
Address of or contract seller(number and street city:state,and ZIP code) �_ 1 0
Name of assignee or other owner or holder of mortgage OCT 1' 201�
Address of assignee(number and street citystate,and LP erode •' (
/n / -- IN COUNTY AUDITOR
Does applicant own property in any If yes,what county? Drawer 1�Q (..cC 4� ` (,v If yes,state amount of deduction
other county
in Indiana? ❑Yes D No
A person is not sniffled to this deduction unless the per o Card NCI• O ess that is recorded in the county
recorder's office(including any home equity line of credit:.._.._.....- 'or the deduction.
COUNTY AUDITOR
Deduction approved in the aneunt 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
I contract er's fu buyer of the atoreme�perty o date application is tiled.
5 re(owner's fun name) , L //^ Date(month,day,yea
��� l+��.�/ 10 -' -1 3 •
address rnof appfmMi(n�ber city,stale.an�d� Z19;x1e)
I Al ' `Q1/1 Si— tt P,4,cat�'1 O yi- L-1 '�•O . .
Person authorized by duly executed Power of Attomey or by IC 6-1.1-12417 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.