HomeMy WebLinkAboutMortgage_Rodgers (2) . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
e} FOR DEDUCTION FROM ASSESSED VALUATION ' 1 l C
��'- � State Form 43769(R73I70.15) ,�(1�lyyr\'�_,^Sir4 0I2
Prescnbed by Department of Local Government Finance 1;V15t V`�7- 1,�JrAJ� w1' —`
INSTRUCTIONS File Mark
To be filed in person or by mail. Forme .
Filing Dater 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 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 Mardi 31 of each year the deduction is sought
See reverse side
\for additional instructions and qualdreations.
t(owner Ace ac buyer- on reverse side)
Page number
s c — ri= :boy-coo a..00`� r y2
Assessed value of real property as of Mortgage/Contract ebtadness unpaid as of Mortgage I Contact in(d�ebtedngss unpaid as of �t applicant tee solo
assessment date,current year assessment date,current year•
da�ir�tjori„ DPW+— .
(`�/tiV fV Yes ❑ No
If no,what is his/her exact share of interest? If owned ne ot� spouse,indicate with when
if name on record is different than that of applicant,indicate below. pnupea icy in queshoir Annually A«sqpd
Real Property 0 Annually Assessed
•
r''\�� Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact sellerLOGIN 1 , T
et
Address of mortgagee or contact seller(number and street cloy,state,and ZI code) /\!t"pt_ Y y,i
Name of assignee or other owner or holder of mortgage - -- — DEC 3 2018
Address of assignee(number and street city,state,and ZIP code 0
y 4r
�'I.�
Does applicant own in anyIfyes,what county? D 1":11\'C I- NO ''1 t arMUrlt of eduction
pPproperty ld dyes;Aral
other county •
in Indiana? ❑Yes El No 1 '/- No
A person is not erdGllud to this deduction unless Ire persor Card NO. � �"T redness that is recorded in the county
recorder's office(including any home equity line of credit t sis 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 buye of the aforementioned property on date application is fled.
• afur er5 rut e) I C Date hit ysar) 1!JJ7 ,
• F ` ' number andsfft city,state,and ZIP cd ' l—) I ((,,
atzukitedW
In 1
Person authonz by duly executed Power of Attorney or by IC a-1.1-14-0.7 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 S10,000.