HomeMy WebLinkAboutMortgage_Garrett (11) Ca STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION �(t ] p�' �c�1
State Form 43709(R13/10-15) 1��f'1 ,'10 v L..c l9
'-- Presorted by Department of Local Government Finance -�J
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 County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county County Recorder
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
ARsot(owner or buyer- rases on reverse side)
b>>✓ ii ce ) Cawcl
Taxing District Key number/legal description Record number a l ) .
number
f1-lot oK1� ,- 7 -04-boo-too • G 61 -021 2p 1 7
Assessed f real of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sae
assessment aurem assessment date,current year data of aplimit !J (�"�Y� legal or liftable owner?
k h /s,o V° Yes 0 No
If no,what is this I her exact share of bxterest7 If owned with ne other than spouse,indicate with whom
If name on record is afferent than that of apprxant,indicate below: property in question:Annually Aeseceed
Real Property ❑ Annua(fyAssessed
i
' v /\ y�''� MobdeHome(IC 61.1-7)
Address of mortgagee or coName of mortgagee or ntntract seer(numbect seller — r state,and ZIP
FILED
Name of assignee or other owner or holder of mortgage FEB 14 2019
Address of assignee(number and sheet,city,state,and ZIP code) - _
' •
�I 4 .I
rM11.
Does applicant own property in any If yes,n 1l Q x ad( •LjBI'F M mount of deduction
in other
❑Yes El No
f?'r"❑'Yes 0 No
A person is not entitled to this deduction t or contract indebtedness that is recorded in the county
recorder's office(including any home equ Drawer NO '^/ I ace)that is the basis for the deduction.
Deduction approved in the amount of: Card. O
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 I contract buyer of the aforementioned property on date application is filed.
Signature(opwn�er�s full name) Date(month,day,year)
)( pain_,,K.
2- 14 -1 q .
Full resident address of applicant(number end et,c� _ P a C\ 111W SQ6S )) U iktmA11c -on4 -6C )Person authorized by duly executed Power of Attar/my 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) _
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,00D.