HomeMy WebLinkAboutMortgage_Sloan STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
;'f f: FOR DEDUCTION FROM ASSESSED VALUATION Co� Township Y
�_�-��,'=� State Form 43709(R73/10.15)
Prescribed by Department of Local Government Finance
INSRUC7 be
To be filed inn person
son or by mail. To
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",V Elditor
located on or before January 5 of the immediately succeeding calendar year. �1 2 ,County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county U_ld
where the property is located during the Mahe(12)months before March 31 of each year the deduction is t
PICSee reverse side for additional instructions and qualifications.
�. �.
Appfirant(owner or contact buyer-see restrictions on reverse side) UN C { —
\'_4.`-Se. l c �UNrY April.�^^.��
Disbi) number I legal Record number Page'n5mber
Iter\Cte_.-ccn ' �-Vail -aok_A - 0OO.30\ -C,r ao% a 39 o"7
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage!Contract indebtedness ugQaid as -1s the applicant the sole
assessmnud date,current year assessment date,current year dam'l�pl" ` to..4 }�QV Clegal or equim owneR
N.
If no,what is his/her exact share of interest? If owned with someone other than Vie,indicate with No
A fl a1Soo \
If name on record is different than that of applicant,indicate below. Is the in question:AnnuaIN Assessed
[deal Property 0 Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller _
/I lie lid Li 1 r i NA/i,At------
Address of mortgagee or contact 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
other 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 a-edit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount o - _.F.
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 1 contract buyer of the aforementioned property on date application is filed.
Signature(owner's br0la1 ,0 / Date(month,day,year)
•Full reside t `/"J•°'/gg'tt( ben store ?land, d ZIP code) /i /
V Ire. 04p piwtieQ-7-0(), /it/C(74,70
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 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.