HomeMy WebLinkAboutMortgage_Seale (2) t?' a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Ceti FOR DEDUCTION FROM ASSESSED VALUATION
'. State Form 43709(R13/10-15) 963( l h�1 .
�" Presc tted by Department of Local Government FinanceV
INSTRUCTIONS: File Mark
To be filed in person or by mail. F rm 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) Mobde/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 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Appli nt(owner or corny -see restrictions on reverse side)
xajhanl a ' L\ ceo.�e.
Taxing Key number/legal description — um a�
t.4
Ass `� - 9 oOl -026 l
01 MortgageContract indebtedness
unpaid as of Mortgage ebtMnessyQpaid as of Is the applicantassessment date,ament year assessment date,anent year date of appl fj✓ legal or equitable owner?
❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with eore i -•itian spouse,indicate with whom
If name on record is different than that of apprrcant,indicate belay( • property in question:Annually Assessed
eal Property ❑ AnnualyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller c1Nsfi ,q--�
J
i
Address of mortgagee or contract seller(number and sheet city state,and ZIP code) �" )
Name of assignee or other owner or holder of mortgage t u i
Drawer NO
Address of assignee(number and sheet,city,state,and ZIP codser
r • ..•i(�t.0R
Does applicant own property in any If yes,what county? Card O. it yes,state amount of deduction
other county
in Indiana? ❑Yes ❑No ,,// /
A person is not entitled to This deduction unless the persa Dt �7 OU 1$3 S Tess that is recorded in the county
recorder's office(including any home equity line of credit t for the deduction.
COUNTY AUDITOR
Deduction approved in the amount ot.
•
20 20 20 20 20 ' 20' 20
Signature of County Auditor County •
Date(month,day,year)
I/We certify un , n- of • - ..••ve and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I co , -r o m e re - •2,_-- •roperty on date application is filed. C/�'�°�'I11f°/�°_��X( yI1I
Signature( s Dal¢(z 1 yl
resid- _ � t("r ber n0 city,state,a ZlP code) 1
carvin
Person authorized by duly executed Power of mey or by.10-L1-12 .7 J 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 hat years and a fine not to exceed$10,000. .