HomeMy WebLinkAboutMortgage_Clodfelter STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION 1Cou�nty Township�j Year r
�'/- State Form 43709(R13/10-15) G f]apt/) F� 1�_ L, 20 lM
Presutbed by Department of Local Government Finance Ul��r ,Jl/Jlf(()),!/U�J
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form 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 Author or County Recorder of the county where the property is unty 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.
ApppmNe\C.. orwntraa buyer-sect (' reverse srde) j h U
Taxing c- 1 V�� {� UI umber'l'1 `, —Jo`�—Qo V• 1 ` 1 . O26 number
-ORecriter 6 S
Assessed value of real property as bf Martgag-, i.. _ btedness unpaid as of Mortgage I Contract indebtedness unpaid
—Rewriter
of Is the applicant the sole
assessment date,anentr O eel date of a iation legal o owner?
year 4 a Yes ❑ No
If no,what is his/her exact share of interest? If aimed with someone other than spouse,intricate with whom
If name on recall is different than that of appliant,indicate below I��property in question:Annually A.�sed
X r� ) \Real Property 0 d
MoAnbile
6
t� /� n FILED
�DpD{ Home(IC frt.t-7)
Nacreotnortgagee.• •• •-• - I )n ^ I_ ce �C�J.y�\'1{�11'e ? y � JL g11 ED •
Address of mortgagee or contract seder(number and street city,state,and ZIP coda)
Name of assignee of oterowner or holder of mortar FEB 6 2019
Address of assignee(number and street city,state, /�
18- ic95a �T/J�a�1
Does applicant own property in any If yes,what a alre�tSt"NlfeC tron
otinI diaanna?nty ❑yes ❑No s ❑No
A person is not entitled to this deduction unless tot indebtedness that is recorded in the county
recorder's office(including any home equity fin_ _. ___...._.._.__.___...__ ____, _ _ 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 coned and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
x
S aN (own 0 Date(month,day,year)
c1
Fyttre;jdennt address of numbe,and street and ZIP code) '5� —\k+b�2 ` /Off\
Person a authorized duly executed Power ofAttoreey or by IC Date(month,day,year)
Address of outhunted 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.