HomeMy WebLinkAboutMortgage_Nelson (4) t s . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-: FOR DEDUCTION FROM ASSESSED VALUATION ,�, !G.
- Y State Form 43709(R13/1015) I N.INCin r• 1
; '� Prescnbed by Department of Local Government Finance JJ 1 •
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 properly 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 Properly: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.
App m nt( Of contra buyer-see on reverse side)
�- de re tie 1 IIe.U0^ .
Twang District Key number/legal description Rend number Page number
40` ?`1\e. 26-NS — 01 103 -COO • i n —0 22 20 0 9 I;4-6 O .
AcW value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage I pad indebtedness unpaid as of Fs the applicant the sole
assessment date,current year assessment date,current year date of ap O O legal or noble owner?
Yes ❑ No
If r1o,what is his 1 her exact share of interest? If wined with ne oU1r than spouse,indicate with whom i/
tf name on rand is different than that of appri ant,indicate belwr. property in question:Annually Assessed
Real Property ❑ AnnuatyAssessed
• Mobile Hone(IC 6-1.1-7)
Name of mortgagee or contract seller 5 T$+ ^,r 4 ' �) f$( E
•
Address of mortgagee or contract seller(numbed and street city,state,and ZIP code) FILED
I !1�� .
Name of assignee or other owner or holder of mortgage JA N2//2LLL 201J .
9L�
Addre I/ ( I (� fy Does tj� es r{ & I I 131 6O V 'axing Dry? Has
detoYm AUDITOR root deduction
Does
' \l� \L}V 1
in Ind current year? ❑Yes No
A per. lance on the person's mortgage or contact indebtedness that is recorded in the county
BOOR IA I Qib y (4 /3I - tided in the county recorder's office)that is the basis for the deduction.
Y1'J� \1 `� COUNTY AUDROR
Deck
dcopt _ (LOU`-' 20 20 2�. 20
Signature or county Auditor County - Date(month,day,year)
I/We ce ' under the penalty of perjury that the above and foregoing information a true and coned and that the applicant is a resident of Indiana and
owner ntrad buyer of the afore ntio ed property on date application is filed.
XSl (owner' hull ��% Date(month,day,year)
•
sog address of apt o robe and street city state.e d ZIP code)
A.
Person authorized by duty executed Power o/Atlo eyor by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street ay,state,and ZIP code)
-
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.