HomeMy WebLinkAboutMortgage_Neil �, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
. State Form 43709(R13/10-15)
Prescribed by DepartmeM of Local Government Fence
INSTRUCTIONS: _ . File Mark
To be filed in person or by mail. 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 0 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 Marlt year the deduction is sought
See reverse . for add t onal instructions and quaffications. 1241
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Assessed value of real property as of ,I(/Mortgage/Contact indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of I Is the applicant the sole
assessment data anent year I assessment date,current year date of application y r/-//11 n/ al) legal or equitable owner?❑ Yes 0 No
Ifwith no,what is his/her exact share of interest? If owned someone other than cjLc ,indicate with whom
If name on record is different than that of applicant indicate below: Is property in question:Annually Acwcced
Real Property 0 AnnuallyA d
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller / �eil ij NV'
Address of mortgagee or contact seller
/of7e
(number and sheet ray,state,and ZIP code) /% LIED
or ho
Name of r o C..ti[L�eP de 4l0 T r �Z /7 'a-}AIOV��2666 2018 . 333ht
Address o ' n umber and street city,state,and ZIP code) �!��'�^,�%��'�+�*��r
Does applicant awn property in any If yes,what county? What Taxirt^�et<kt?._ ,I Has this deduction been requesTed�1 �'� nt of deduction
other county ❑Yes ❑No -'�.•.••-- ..__ ——
'AUDITOR
in A person is not entitled to this deduction unless the person has a balam s recorded in the county
recorder's office(including any home equity line of credit that is recorde Action.
0 D1'a\1'CI" NO I (J
•
Deduction approved in the anrount of. .�//''
20 20 2a_ Card NO. t `� - l - 20
Signature of County Auditor County - I I,day,year)
II 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
4.0 owner I contract buyer of the aforementioned property on date application is filed.
SignaaWWree(owner's full name) �/"/� Date(month,day,year)
�'4si r' '. �t. Yi`\' A r. X
Full resident
address` of applicant`(number
�and sheee�.t,city,state,and ZIP
III PP\+code) \ -�.\ I �1
- 1a.\a n authorized ry F.
` . Power) of AtWrttey or.by C 67 7`72\cmr-t1 e Ai , I -1 l 0k QC) Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) 111
The penalties for penury can include imprisonment up to two and a hat years and a fine not to exceed$10,000.