HomeMy WebLinkAboutMortgage_Norman STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
rHopolbFOR DEDUCTION FROM ASSESSED VALUATION
State Fonn 43709(R13110-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: - • File Mark
To be filed in person or by mail. Fo„ Fa* 101.
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 prope rs j iu ir•ditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobde/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 March 31 of each year the deduction is sou it.C 4 234,3
See reverse side for additional instructions and qualifications.
t(owner or connect buyer-see re.- -(ma..on reverse side)
efcroy W Nam ail,
Taxing District Key number/legal description G I f3 %q1 r ®ktNT Ps lore
Z(o-. 3- 02-Soo -p,S/9-zR4 DO- 2.0)�, 31,G9
Assessed value of real property as of Mortgage I Conrad indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,aurent year assessment data,current year date of application owner?legal or equitable owner?
18 f k'2 5 REDAY /ft9npt&J 0 Yes 0 No
If no,what is his/her exact share of interest? J If owned with someone other than spouse,indicate with whom
If name on recall is different than that of applicant indicate below. Is the property in question:Annually P«ced
❑Real Property ❑ Annuafy Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller n •
r ' �(
W�14Ln C/Q� l"t(1LOr-t-YLi q — I't U •
Address of mortgagee or contract seller(numbefi and abed,city,sate,and ZIP code) 11
Name of assignee or other owner or holder of mortgage Drawer 1n O... Ol
Address of assignee(number and street city,state,and ZIP code) Card NO U W 1
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
in Indiana? ❑Yes No on
property
r ❑Yes El No
A person is not entitled to this deduction unless the person has a balance on the person's mot gage or contract indebtedness that is recorded in the county
recorders 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
jl owner I contract buyer of the aforementioned property on date application is filed.
�U Signature/cairn's fur/mine) Date(month,day,year)
Full residad address ofapplicant(nunfber and sleet city,state,and ZIP code)
Jr•
I¢ er-4 S— S97 Try 'Po w A/4„/rTc /iT- 4 iety .
Person authorized by duly executed Power of Attorney or by IC 1.1-12-0.7 Date(tawax,day,year)
Address of authorized person (number and street rdy,safe,and ZIP code)
The penalties for perjury can include imprisonment up to two and a haff years and a fine not to exceed$10,000.