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HomeMy WebLinkAboutMortgage_McCoyI STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION ''% State Form 43709(R13/10-15) Presalbed by Department of Local Government France INSTRUCTIONS: _ _ File Mark To be filed in person or by mail. rm fi�g,�,a•��• Filing Dates 1) Real Property Must be Completed and dated in the calendar year for which the deduction is sought I p Must be filed or postmarked with the County Auditor or County Recorder of the county where the property Sr •o d= f or located on or befom January 5 of the hmnediately succeeding calendar year. ❑ County Recorder 2) Mobde/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county pE(' 7 201ht where the property is located during the twelve(12)months before March 31 of each year the deduction is sought - See reverse side for additional instructions and qualifications. Applicant(owner or 0buyer-see resvrcaooAgJsoCn reverse side) i\( { ( IS O_N T, {.,: RTaragD '� - fl dI IDL- ©4l•11q f r Z011 310► Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/cwrea. indebtedness unpaid as of Is the applicant the sole assessment date,current year assessment date,current year datsse application legal or equitable owner? ?O, CI Yes ❑ No If no,what is his/her exact share of interest? If owned with someone er spouse,indicate with whom If name on record is afferent than that of eolith:ant,indicate bebw. Is the property in question:Annually Assessed ❑ Real Property 0 Annually Assessed • Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller nA �\�I I.0 CJ gs"- aSi�nahu✓t� Address of mortgagee or contract seller(number and street rdy,state,a code) Name of assignee or other owner or holder of mortgage /1 ^^�� Address of assignee(number and street city,state,and ZIP code) //� 1 Drawer NO i^lI2I.JIIl Does applicant awn property in any If yes,what county? What Taxing District? Has this deduction other county on property for in Indiana? ❑Yes ❑No current yearl I Card NO. 2I.�\I A person is not entitled to this deduction unless the person has a balance on the person's mortgage or cc ((((.•••....IIII lJ recorder's office(including any home equity line of credit that is recorded in the county recorder's offnz)1..,........_ ._. _._ ___ COUNTY AUDITOR Deduction approved in the amount of 20 20 20 20 20 20 20 Signature of County Auditor County • Date(month,day,yew) 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 er ntract buyer of the aforementioned property on date application is filed. 5' tut name) \J ( I Date(month,day,ye Ia 7-I all app t(number state ZIP code) �a 4 °i�� dwt, vt 1 I n Lem.(o(AS n 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 sheet 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.