HomeMy WebLinkAboutMortgage_Woods e STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
L FOR DEDUCTION FROM ASSESSED VALUATION
_ , State Fonn 43709(R13110-15)
<-- Presabed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by malt. 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 or postmarked with the County Auditor or County Recorder of the county where the property is 0 County Auditor
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 County Auditor of the county ❑ County Recorder
where the properly is located during the twelve(12)months fore March 31 of each year the deduction is sought
See rove side for additional instructions and qualifications.
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Tc • Key number/ description Record numPage mber
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Assessed value of real p ,//p%� Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant be sole
assessment date,aurerdn yea / assessment date,current year date of application pc legal or equitab'e owner?
ice;t/Q0- ❑ yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than sponse,indicate with whom
If name on record is different than that of appliant indicate below. Ise progeny in question:Annually Assessed
pg Real Propev? I Annually Assessed
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- Home(IC 6-1.1-7)
Name of mortgagee or contractcontractseller 5/ /Y�� r /
3
Address of mortgagee or contract seller(number and abeet M:state,and ZIP ode) 4/0
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Name of assignee o other cone er of g`e �L `J / �i V l J 20r8
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Address of assignee(number and cfi:state,and LP code) ` r-n� N G`OU_,KrIGY,ii7Lr�
Does applicant own property in any If yes,what aunty? What Taxing District? .._- ._. _._._.. __ _ __ _. ,.- . ._ nation
'mnindiaana H ❑Yes ❑No /I lit p.rp LC WTI
A person is not entitled to this deduction unless the person has a balance on the 1 f V ',l/ the county
recorders office(including any home equity line of credit that is recorded in the a 2 C ./A �J V V rt 11'
COUNTY A
Deduction approved in the amount of:
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20 20 20 20 i! Ph �h r r-J �1 0
Signature of Canty Auditor C .l /per /�
I I We certify under the penalty of perjury that the above and foregoing informa liana and
owner
I ra contract name)
the aforementioned property on date application is fib (J / 3 3
/ye ,/4,
Full resident address of applicant(number and street city,,state,and ZIP code)
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Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
Address of authorized person (number and street city,state,and LP code)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000. _ .