HomeMy WebLinkAboutMortgage_Hurlock (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
t:?
FOR DEDUCTION FROM ASSESSED VALUATION
f` State Form 43709(R73/10-15)
Prescribed by Department of Local Government Finance
INSTRUCT)ONS: File Mark
To be filed in person or by mail. Form filed with:
Filing Oates: 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. 0 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 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contact buyer-see
1rressaictions on reverse side)
Taxing D" �r Key number/legal desaiptioa. Record number Page number
lCIncA C aL.2-\1/4-\-- l`i - COI -• 9;;O • 7Sa-0o1 201 9 02u 3
Assessed value of real propmtMif Mortgage!Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole •
assessment date,and year assessment date,aurent year date of a plicauon e . legal or equitable owner?
4 91 a� — G ❑ No
If no.what is his!her exact share of interest? If owned with someone other than spouse,indicate with whom
d name on record is different than that of applicant,indicate below. Is the in. _!,. y�1i , Assessed
\ ssessed
• '.i.-r' IN . lti.7i 1.1-�
Name of mortgagee a`coonttaa�ct ssee`lleerr`���,(�-
Address1 ell of mortgagee or contact seller(number and sheet,city,state,and ZIP code) 30 5 2019
•
Name of assignee or other owner or holder of mortgage /
•
Address of assignee(number and street,city,state,and ZIP code)
likeSGN CUUt1Sy AUp1TGR
Does applicant own property in any If yes,what county? I What Taxing District? Has this deduction been requested If yes,state amount of deductionin
other
❑Yes ❑No __ �f "r- ❑Yes ❑No
A person is not entitled to this deduction r, v/ 9 _ Q ,�- Lis entreat indebtedness that is recorded in Me county
recorder's office(including any home equ. r that is the basis for the deduction.
N Drawer O
Deduction approved in the amount ot.
Card NO.
20 20 . ' 20' 20
—
Signature of County Auditor I wumy 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.
Si nature(owners tun name) Date(month,day,yeap
\D`&
friell
resident of appli an number ci state,and LP e)
to� �sdby Vi - •Lk-1� u. �
erson authorized by duty ex etl Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,slate,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.