HomeMy WebLinkAboutMortgage_Taylor (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year j
• ='\ FOR DEDUCTION FROM ASSESSED VALUATION
`\ ` —
�•S State Form 43709(R13110-15)
Prescribed by Department of Local Government Finance -
INSTRUCTIONS: 1 .
To be filed in person or by mail G
Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the dec
Must be filed or postmarked with the County Auditor or County Recorder of the cou Drawer NO.. e ( 0
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Cc -locatedI
where the property is during the twelve(12)months before Mardi 31 of cacti Card NO. t L J
See reverse side for additional instructions and qualifications.
.A\ ('ant(owner or contract
buyers,.-,ys �/reestrictionrs�on reverse sue\ `—, , 1 I
)3tA�l,n Lc 4- 1 ' ckvV 0�/I r `C.3L]�..0.1( . (�
IZV �ivtr • yid —o1\-d iJ-�.1 -OCO . 0 O -O S) Record number • Page number
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage l Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year datE�f pppliratw¢, legal battle owner?
/poi L her than Yes 0 No
If no,what is his 1 her exact share of interest? If owned with someone than spouse,indicate with whom
If name on record is different than that of applMant,Skate below. Is the property in question:Annually Assessed
❑ Real Property 0 AnnuallyAssessed
P.bble Home(IC 6-1.1-7)
Name ol mortgagee or contact seller &v c ( �� . FILED
Address of mortgagee or contract seller(number and street,city,state,and Zl code)
Name of assignee or other owner or holder of mortgage NOV 1 2018
Address of assignee(number and sheet city,state,and ZIP code)
lilt wit 4►r
Does applicant own property in any If yes,what county? What Taxing District? Has this deductral Berbeirgugelj
� amount of deduction
other county on pro for • 4 I ITOR
in Indiana? ❑Yes El No current yeah ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the persons mortgage or contract 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 for the deduction.
COUNTY AUDITOR
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 coned and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signature fue / Date(month,day`,ye
rs /. _ 11 - l-- -
Fuq rgsitla.qt Z dress of a�numberi streeLtdlyrl#ateW\"ZIP �f 1 Th 6
Person auN by duly d Power of Attom or by IC Gi.t-11v'z�l-0.7 —+� I (' b 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 Me and a half years and a fine not to exceed$10,000.