HomeMy WebLinkAboutMortgage_Blandf
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ir'f FOR DEDUCTION FROM ASSESSED VALUATION
'" State Fotm 43709(R13/10-15)
�- Prescribed by Department of Local Government Finance }'I F'
INSTRUCTIONS: ��� �fd�
lb be fled in person or by mail. - • filed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is so n EC 5 20 :
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is .l County Auditor
located on or before January 5 of the immediately succeeding calendar year. /1 .unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must fife with the County Auditor h 1.
where the properly is located during the twelve(12)months before March 31 of each year 1 Y A U D I TO R
See reverse side for additional instructions and qualifications.
Appficanr[rymv3 IS l
bele5 see re on reverse.side)
KK
T atnct Key number/legal description Record number Page n�;e
Y1Mce ^ 26-12-c7? -cSb3- O03 . 100 --O29, 20 f kaTr .
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applca sole
assessment date,aunern year assessment date,current year date application y .�-+7 03 legal or ble owner?
I2S 2- a, — Yes 0 No
If no,what is his I her exact share of interest? If owned with someone ither than spnnse,indicate with whom
if name on record is different than that of applicant,indicate below. / Is property in question:Annually Assessed
Real Property 0 AnnuapyAc,Pvsed
• { Mobile Nom(IC 6-1.1-7)
Name of mortgagee or contract seller Cii i ' `1 6:
Address of mortgagee or contract seller(number� and street, ZIP code) 3—rTTyt�! J
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own puppetry in any If yes,what county? Mat Taxing District? Has this deduction been requested If yes,state amount ofdeducbon
other county on property for
in Indiana? ❑Yes ❑No current year? ❑Yes 0 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 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,yea)
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
..—buyer of the aforementioned property on date application is fled.
:E'
e' r •e)) // Date(moidaytyear)X �t��f.Odd\nu and _reetLcity,state,and LP code) 1
SO ore cin�y 11� �i7c >v ' �1 7 6 7 0
Person authorized by duly executed Power of Attorney or IC 11..1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for penury can include imprisonment up to two and a half years and a fine not to exceed 510,000.