HomeMy WebLinkAboutMortgage_Young (3) } STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
..`' �`;'' FOR DEDUCTION FROM ASSESSED VALUATION ///���`
'- State Form 43709(R13110-15) 9 VI 10l2 •
- Presamed 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 orposbnadred 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. ❑ unty 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 befom March 31 ofearh year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or -Fee
Tov�kes 4- KN � C `J' o con
g Key number�prion n r P e umber
ID won ;q • f _ -tq—to 3 -coo . o� -006 of „,-../�
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtednes3 un id as of Is the applicant the sole
assessment date,armed year assessment date,current Year "II
ate gxabqu_ 'lacei.(, legal or Rattle owner?
�74'l�'-/lt Yes 0 No
urn,what is his/her exact share of interest? If owned with ne other man spouse,indicate with whom
If name on recall S different than that of backbit,indicate below:
XR property in questbir Annually Assessed
Real Property ❑ Annually Assessed
,/� Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller f��i (�/���\ ' 1 • F g L"E"1 D
Address of mortgagee or contact serer(number and street city.si3e,and ZIP code) ,T-/i 1A.n` C9./� 1 FILED
Name of assignee or ober owner or �holder of —
�J 11'' OCT 11 2018
Address of assignee(number and street illy,state,and ( P N
,tuts
l.''nn'tj co ptTv A(1DITOR
Does applicant own property in any If yes,what multi �1n-,n�— 1r1Kuested If yes,state amount of deduction
Indiana?other county in ❑Yes ❑No tflaU s ❑No
A person is not entitled to this deduction unless the, d indebtedness that is recorded in the county
recorder's office(including any home equity line of. 1 5— 4 0 S S :the basis for the deduction.
Deduction approved in the amount of.
20 20 20 20_ 20 20 20
Signature of County Auditor County • Date(month,day,year)
•
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/contract buyer of the aforementioned property on date application is filed.
K.Cri2(gass Idname) Date(month,day,year)
1 10,11 - 13
•1212'8�. f (nu •. •1^� slate,and c) C� -D�n - cl�6 6 t7
Person authorized by duly execute• d Pa$e of N oormey or 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 perjury can include imprisonment up to two and a hair years and a fine not to exceed$10,000.