HomeMy WebLinkAboutMortgage_Canillas (2) � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
- State Fonn 43709(R13/10-15) f�, 9 3 0 y\ Py ,� _-I�
< - ` Presabed by Department of Local Government Finance J - • '1��V~
INSTRUCTIONS: File Mark
Tb be filed in person or by mail. Form filed with:
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 property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. CI 2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county County Recorder
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 n.mntract -see 2 on reverse side)
Jqe, ea. L. I- ShiN na✓ CY Cani Ik .
Taxing District Key number/legal desoiption Record number Page number
26- 1\-12--3o\ - po \ .-3--S-+ - 028 . 2013 51i-6 -
Assessed value of real p,upea y as of Mortgage/Contract indebtedness unpaid as of Mortga e/Contact indebtedness teidd as of Is the ap • nt the sole
assessment dale,current year assessment data,current year date l r O 3 legal o eq We owner?
es ❑ No
If no,what is his/her exact share of interest? If owned with meone other an spouse,inticate with whom
If name on record is different than that of applicant,indicate below: I property in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller P f(� Vv'(11,1 1�1
Address of mortgagee or contract seller(number a 1,city,state,and ZIP code) �r 1�I' ;,i
Name of assignee or other owner or holder of mortgage DEC 2 7 2018
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? HaI�igeethic imsbejR(erqueesied ii I( es,state amount of deduction
other in Indiana?nty ❑Yes ❑No curren on t yeeaa for—LJ Yes ❑No U
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.
1'Signature(owner's rw name) Date(month.da, ar)04
F ti • en ad applicant(num ran sleet city,state,an P code
Person authorized by duly executed Power of Attbmey 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 twv and a half years and a fine not to exceed$10,000.