HomeMy WebLinkAboutMortgage_Bruce (3) a,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
tkic=r., FOR DEDUCTION FROM ASSESSED VALUATION
�= � State Fortn 43709 Department
o Mk
Prescribed by Department of Local Government Finance
v
INSTRUCTIONS: _ ` Fie `-fk
To be filed in person or by mail. 1`� 7 •nn filed with:
Frig Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought NQv
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is w� - •unty Auditor
located on or before January 5 of the immediately succeeding calendar year. •I OP • h 0=-corder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the I pt,••
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction' oi •
See reverse side for additional instructions and qualifications. snN C
Applicant(owner orcoon{tact buyer-seee suictions on reverse side) G1�
z oiSU xflj of\ACe
Taxing Key number/legal description Record number Page number
o61.1aINC1 � c21 -1y• 18-to; - Co\• aol-col I'1 ?S�t�4
Assessed value of real p Mortgage!Contract indebtedness unpaid as of Mortgage/Contract indebtednessrY
.(�� unpaid as of Is the applicant the sole
assessment date,current v
year assessment date,current year date of application legal or equitable owner?
a I�-{ �• ❑ Yes ❑ No
t no,what is his I her exact share of interest? If awned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below Ls the�property, in question:Annually Assessed
• tlrM J Property 0
Mobile Ara s 61.1-7)
of mortgagee or contact seller
cadnP--i a. riY, ehe.le ' r�.kCC
Address of gam+contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and 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
otter county on property for
in Indiana? ❑Yes ❑No current year? ❑Yes ❑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 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 correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sig'.re(owners full name) Date I ^ t 3 'ail
F W .
a�_ .- J:tlressw applicant(number and sheet aty,state,antl LP axle)
X q aK WPrr Ilviui Qakhw4 (a-y4Tiv Y7`60
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Dale(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.