HomeMy WebLinkAboutMortgage_Seib (6) s., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
J FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: _ File Mark
To 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 fled orpostrnarked with the County Auditor or County Recorder of the county where the property is 0 County Auditor
boated on or be fore January 5 of the irmnediatey swxeding calendar year. ❑ County Recorder
2) Mobile I Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county
ere the properly is boated during the twehe(12)months before March 31 of oath year the deduction is sought
See reverse additional in sand qualifcations.
Applicant own o
Tape istrict Key number/ ;—.•.;. n r Page nu be "
Z - ft 36.- �c3-de0. c162- CO9 fol i
Assessed value of real property as of Mortgage/Cormact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment dap,current year assessment dap,current year date of appr� '•et) legal or equitable owner?
Wy � El Yes El No
•
Ito,n what is his/her exact share of interest? If owned with spouse,indicate with whom
If name on record is different than that of applicant indicate below. I . /�''r question:Annually Assessed
Assessed
NOV of ..1 •-�..- ❑1. two 1.1-7)
Nacre olmortgagee or contact seller 611"-' i1 r / ]'//J(� 20J8
Address of mortgagee or contract seller(number and street,thy,sstatte,andlZIPG' BS°'
NCOUA' ' '
Name of assignee or other owner or holder of mortgage 1 ^ `/ T /� ,t
9 t /o I W' e° -- /�OOQl�dUd
Address of assignee(number and sans,city,slate, Ad Pa.e) /I — —
Does applicant own property in any If yes,what r ' / n
other
county
in Indiana? ❑Yes ❑No
A person is not entitled to This deduction unlee unty
recorder's office(induding any home equity lit
Deduction approved in the amount of V v
-4
3
t s
) —3—
20 20 ` _
—_ Cho M O Signature of County Auditor �� `\^� t
I/We certify under the penalty of perjury 0 �i v and
owner/contact buyer of the aforemention / C <5 CiTh
e p J' � 0 \;t•—)—I Do d
Full resident address of applicant(number and she
X )Oct S . t) 05Gt Vr
Person authorized by duty executed Power ofAtton.,v...r ,-._...
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. _ . _