HomeMy WebLinkAboutMortgage_McCormick cats. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
l FOR DEDUCTION FROM ASSESSED VALUATION
tii;‘,..-..,J.- State Form 43709(R13/10-15) G � \tell\ 2-0 C
S—i Prescribed by Department of Local Government Finance \'\ ` `
INSTRUCTIONS: File Mark
To be filed in person or by malt nn 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) Mobilenty I Manufactured Homes not assessed as Real Properly:Must file with the Cou Auditor of the county County Recorder
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.
APPrt( or contract&. see rest:thefts on reverse side)
eY �cic� _ •
Ttodng I e�4Y\ ign
k PC -1Z g�3o2-Opp.S-lk -02-S 20 1 �' .5121r .
Assessed value of real property as of Mortgage/Contrail indebtedness unpaid as of Mortgage!Contact indebtedness unpaid as of Is the applicant the sole
assessment data,current year assessment date,current year date of a uO legal or itable owner?
5�� Yes ❑ No
If no,what is his I her exact share of interest? If owned with ne other that spouse,indicate with whom JI \
If name on record is different than that of applicant,indicate below I property in question:Annually Assessed
Real Property 0 Annually Assessed
_ Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller _ F I+_,
Address of mortgagee or contract seller(number and sheet city,state,and ZIP code) J J�{
Name of assignee or other owner or holder of FEB a 2019
Address of assignee(number and street,city,: /n(//(� J jJ.
Drawer NO...AI
'ON COUNTYAUDITOR
o�countyppkcnt own property in any If yes,v action been requested If yes,state amount of deduction
in Indian ❑Yes ❑No � -7�� •
7 ❑Yes ❑No
A person is not entitled to this deduction c Card NO. ... ,. ./,,, .•,•,,,,, or contract indebtedness that is recorded in the county
recorder's office(including any home equ ice)that 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 I contract buyer of the aforementioned property on date application is filed.
A S re(owner's fit wee) Date(month,day,year)
mt,
F nr u e s v umber and sheet city state,and ZIP code) ,
IyIU, �y� —�}JE7"i1ff tJh
Person authorized by duly exedit d Power of Aotomey or by IC 6-1.1-120.7 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.