HomeMy WebLinkAboutMortgage_Thomas (2) cSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
P'-`= FOR DEDUCTION FROM ASSESSED VALUATION
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',`., State Form 43709(R13 f 10.15) �r�J\ 36�� R013
Presrnbed by Department of Local Government Finance U\ �+• 1
INSTRUCTIONS: File Mark
To be filed in person or by malt. Form filed with:
Filing Dates 1) Real Properly.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. 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 March 31 ofearh year the deduction is sought
See reverse side for additional instructions and quatificatlons.
Appfaan ner or contract buyer-see on reverse side)
,, nPmomAS .
T Key number/legal description Record number Page number
r1So � 2-6- 2.- DR -3o1- coo.IS L1 -02i-1 Zo\ ' 5'O67- ,
Assessed value of real property as of Mortgage/Contract indebtedness urff,aV as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
accnccment date,current year arse dam cupent yer`Iarn of ( date of application legal or equifase owner?
If no,what is his/her exact share of interest? S(�.\/T If arc spouse,indicate with whom owned with someone other than ❑ Yes ❑ No
If nacre on record is different than that of applicant,indicate below. Is property in question:Annually Accresed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller x E I �„ I ,E D
•
Address of mortgagee or contract seller(number and street ay,,state,and ZIP code)
Name of assignee or other owner or boiler afrrorigage DEC 1 4 2018
Address of assignee(number and street QV,t Xr\• •;
Does •
applicant own property in any If yes,a 'r /(J , •..• rrbon bce�-74t�i C: kfa� (�(ig(luGion
other county DI'811'CI' ��.. �`•••.•
x
in Indiana? ❑Yes ❑No 11911
❑yes ❑No
A person is not entitled to this deduction u 0f l/ny— C/ ' )r contract indebtedness that is recorded in the county
recorder's office(induding any home equi C 1 r d NO. �
534 e)that is the basis for the deducton.
Deduction approved in the amount of.
•
20 20 20 20_ 20 20 20
Signature of County Auditor County Date(month,day,year)
I 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 f contract buyer of the aforementioned property on date application is filed.
S" re(owners full n e) Date(month,day, ear)
x 12- 14 - 18 .
Fidl residerR add E t(n bet rsheet ,state,—arM ZIP— L19-6 IC •
Person authorized by duly executed Pow&r of Attorney or by IC 6-1.1^1--112--0.7 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$10,000.