HomeMy WebLinkAboutMortgage_Tully }. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r, FOR DEDUCTION FROM ASSESSED VALUATION
.,A'�',• Stale Form 43709(R13I 10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail i Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sou �Ip�r •
Must be filed or postmarked with the County Auditor or County Recorder of the county where th B.� !1 �I .with:
my Auditor
boated on orbefom January 5 of the immediately succeeding calendar year. •2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of theme County Recorder
where the properly is boated during the twelve(12)months before March 31 of each year the dedudi•N& 20 r i
See reverse side for additional instructions and qualifications.
Appl4
(owner
T. / restrictions on reverse side)
Tam District • et'numbers legal description CIQ�Ti bdr'JDI7 number
UWr lwtd 2a -m' -/g -4.03 -Dr)/. 233-007 12.01 • ISO
Assessed value of real property of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the ap nt the sole
date,
assessment current year date,current year date of application legal or unable owner?
�.5/n/ Yes ❑ No
If no,what is his I her exact store 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
❑Real Property 0 AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Err-e LL
Address of mortgagee or contract seller(number and sheet city,state,and ZIP code)
ce
Name of assignee or other owner or holder of mortgage —
L
Address of assignee(number and street city,state,and ZIP code)
Does applicant own properly in any, If yes,what county? What Taxing District? Has this deduction requested If yes,state amount of deduction
other count' ',1—�,/ onproperty tor l,�m-
in Indiana? ❑Yes No current year? Yes ❑No
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 fine 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 I contract buyer of the aforementioned property on date application is filed.
Signature(oygeYs full namyy/ Date(Hamill,day,Yam)
Fullresident address/— at applicant(number and sheet dry.state,and ZIP code)
`'/5 E. hack S ief' Oak/0 C ` �A) �l7��O(7
Person authorized by duly executed Power Of Attorney or by IC&1.7-72-0.7 r 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.