HomeMy WebLinkAboutMortgage_Hoskins (2) } STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
uFOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
Presaled by Department of Local Government Finance
INSTRUCTIONS: _ File Mark
Tb be filed in person or by mail. Form filed with:
Filing 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 CounyAuditor or County Recorder of the county where the property 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 March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner tract buyer-see
CX/XJv re�Is � . 0 p Orfad'/C�s a,7
Tier
� / aidcao Record nu t. umber
Ace....d - *property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid`WA/ Is the ap •
assessment ,-. year assessment date,current year date of application I legal or equ' er!
37 /9 �J Wei Yes 0 No
/ c u Ou. 4
If no,what is his/her exact sham of interest? If owned with someone other than cfx>�.d/yh ' 'row•ern
If name on records different than that of applicant indicate below.. Is the pi ety in stiAnnually Assessed
0 Real Property 0 A tI{{��l1Y Assessed
Moblleme(IC 6-1.1-7)
Name of mortgagee or contact seller ry/ �Address of mortgagee or contract seller(number an city,state,and LP code)
Name of assignee or other ether or fader• e e 4 h L.) Ed
/ III Sfil cd/4 7
Address of assignee(number and street city, -.flied"•ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes CI No current year? ❑Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's --" —/"- --" '^—fed in the county recorders office)that is the basis for the deduction.
020 I 0p - 4 t ea c". COUNTY AUDITOR
Deduction
Drawer NO
20_ 20 20 20 20
Signature, Card NO. County - Date(month,day.year)
I/We. >ing inforrnation is true and correct and that the applicant is a resident of Indiana and
�/////////1111�1111wUUUU��`��' owner/contract buyer of the aforementioned property on date application is fled.
( 'Signor e,e tuff name ecto Date(month,day,year)
FulIft dent address of ce��p t�(number and street city,slate,and LP e) /'
1(, �./i W L1_4er l'y Sf _a/ ��6,1 /1/ y7G4-d
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state.and LP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.