HomeMy WebLinkAboutMortgage_Ducharme cr. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
•r'a4J FOR DEDUCTION FROM ASSESSED VALUATION
'.: State Form 43709(R13/10-15)
6 Presalbed by Department of Local Government Finance 11 =
INSTRUCTIONS: - lr-It
To be filed in person or by mail. Form efed wilti J
Filing Dates: 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought QF
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is tr CournpQty Auditor
located on or before January 5 of the immediately succeeding calendar year. I ❑ Cool city Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must fife with the County Auditor
where the property is located during the twelve(12)months before March 31 of each year the dedu
See reverse side for additional instructions and qualifications. L O rq
Applicant(ovmer or rt buyer-see • ,on reverse side) r I UfJ
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o cv „G - 1)r5`-ol- .�G` . /a2 Dof6 guff 2 legal 4•raiption Record minter Pagtnernber 3 .
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of......-piii'• �sj� legal or equitable owner?
is /, 0Gf. 0 Yes 0 No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
if name on record is different than that of applicant,indicate below.. _ is the property in question:Annually Assessed
�l\/Real Rupetty 0 AnnualyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact serer1II—L %}n -, n
Address of mortgagee or contact seller mber and street city,state, ZIP code)
2047.
Name of assignee or other owner or holder of rnortaaoe o / / �t/7��
Address of assignee(number and street,city,state,and ZI )
Does applicant own property in any If yes,what county? Wnat Taxing District? Has this deduction been requested If yes,state amount of deduction
Imhnddiaanna? ❑Yes ❑No cun rrren yt Dior ❑Yes DNo
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,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/contract buyer of the aforementioned property on date application is filed.
Signature( full name) Date(month,day,year)
Full residents of a licantmber and street city,state,and ZIP
I. 10'-1 6 . Sp rl'i..11 SA F , L iJ 217666
Person authorized by duly exeoned Power otattomey or by IC e-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,site,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.