HomeMy WebLinkAboutMortgage_Johnson (16) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
,4�' , FOR DEDUCTION FROM ASSESSED VALUATION
,ica e'. State Form 43709(R13/10-15)
Pf:
Presabed by Department of Local Government Finance
c
INSTRUCTIONS: File Mark
To 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 D County Auditor
located on or before January 5 of the immediately succeeding calendar year. 0 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the properly 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 or contract buyer-see restrictions on reverse side)
SQ hr1 r� . � \ chc\c(w C — - ---1 0 a0 r a .
ac -aarc�i C(o-, - l I fa - coo- 1 �r7 - 007 Z01 2�0
Assessed value of real Mortgage/Contact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment data,current year assessment date,current year date of application legal or equitableowner?owner?
-$ t t"11coo D—❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate.wit whom
If name on record is different than that of applicant.iMiCate below Is 11-ii y,,,,�„„�r�;; tion:Annually Assessed
xRetiLPrroderty ❑ Annually Assessed
• / `� ‘,0,. Mobile Horne(IC 6-1.1-7)
Name of rgggagee or O \ �, ` �V t
(I�JI icp O
•
Address of mortgagee or contract seller(number and street city,state.and ZIP code) O�(i `
Name of assignee or other owner or holder of mortgage4 VC
J '
Cr
Address of assignee(number and street city,state,and ZIP code) _ _ .n\1 (,+.
Does applicant own property in any If yes,what county? W,at Taxing District? Has th // �J(
other county onpra Drawer NO cz V
h Indiana? ❑Yes ❑No surer
A person is not entitled to this deduction unless the person has a balance on the person's mork q.,�\
recorder's office(including any home equity line of credit that is recorded in the county recorder Cat- 'd N O. 3 (�( )
COUNTY AUDITOR Y _
Deduction approved in the amount of:
•
20 20 20 20 20 ' 20' 20
•
Signature of County Auditor County Date(month,day,year)
I 1 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 rementioned property on date application is filed.
Trnets fly e) Date(month,day,year)
Full r address of app. umber sheet city.state.and ZIP e)
Irmo i Mr lit Oi. r aaklall Cif , s)31 K76(0
authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state.and ZIP code)
Mir.ihe penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.