HomeMy WebLinkAboutMortgage_Moore (13) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS { County I Township I Year
' 7 FOR DEDUCTION FROM ASSESSED VALUATION
';� °- Slate Form 43709(R13 I10-15)
�= Prescribed by Department of Local Government France IC
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INSTRUCTIONS: u t a J �i
To be filed inIperson or by mail (/U�('
Filing Dates' 1) Real Property Must be completed and dated in the calendar year for which the Dr a war N 0
Must be fled or postmarked with the County Auditor or County Recorder of the '
located on or before January 5 of the immediately succeeding calendar year. , ri lei
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with th Card NO.O.
where the property is located during the twelve(12)months before March 31 oh
e
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see resstttioonss on reverse side)
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tC1"g District .Jt t aKey umber/legal W_ yS aipfion�- I O 1��D . D a�`Q^f a- Record number Page number
Assessed value of real property as of Mortgage I Contract indebleuness unpaid as of Mortgage I Contact inaemearless unpaid as of Is the applicant the sole
a«cment date,ciurrard year assessment data,anent year date of application��r b0 �"" legal or aaiiiaxa owner?a ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse.indicate with whom
If name on read is afferent than that of applicant,indicate below. Is the property in question:Annually Assessed
0 Real Property 0 Annually Assessed
• Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller Pit
Address of mortgagee or contact seller(number and atrret tdy,state,and ZIP code)
Noy-cab
Name of assignee or other owner or holder of mortgage l 0
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n.
Address of assignee(number and street city,state.and ZIP code) �r8,5`o��6�,i,_ .,
Ca 7*
oDoes ther applicantnyawn property in any If yes,what county? What Taxing District! o es��deduction been requested dy8s, Ua amount of deduction
in Indiana? ❑Yes 0 No anent year?or ❑Yes 0 No �/lr1p
A person is not entitled to this deduction unless the poison has a balance on the person's mortgage or contrwt 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 I contract buyer of the aforementioned property on date application is filed.
naiur (�vners MI ram Date(month,day,year)
y /ate ll- o-IS .
Full resident address of t(number and street cdl: .and ZIP code)
X 02 5516 r u.kutriJ du. A.n(utex. V77 2174 70
Person authorized by duty executed Power of Attorney or by IC 5-1.1-12-d7 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 two and a half years and a fine not to exceed$10,000.