HomeMy WebLinkAboutMortgage_Wallace STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' 'I�,„ FOR DEDUCTION FROM ASSESSED VALUATION !r�—,� �
',`.._ i'., State Form 43709(R13/10-15) ��son Ga )� 20 IQ
Prescribed by Department of Local Government Finance J l
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 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. 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 t((owner or contra -see rg ' on Ce side)
f7�\�n f�. 'J\ ,
T. cig District Key number/legal description '1 nugi a ''fiber
llkAu.. 2G — 1 2 --O2--�Ob — col .-6t —00 1 , A u /�
Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant the sole '
a'tetvnx;nt date,current year assessment date,current year of application }y��``'�1 legal or uitable owner?
CMG 50 0 lX Yes ❑ No
If no,what is his I her exact share of interest? If owned ; someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below- Is property in question:Annually Acspcted
. (-4 Real Property CI
Annualty Assessed
O Mobile Home(IC 6-tl-7)
Name of mortgagee or contract seller ^ _ ) 51\
Address of mortgagee or contract seller(number d sbee ' ,state,and ZIP code)
Name of assignee or other owner or holder of mortgage RILE D
Address of assignee(number and street,dry,slate,and ZIP code) MAR 01 2019
•
Does applicant own properly in any If yes,what county? What Taxing District? Has this deduction been requ ted yes,state amount of deduction
other county on property
in Indiana? ❑Yes El current y No
A person is not entitled to this deduction unless the person has a balance on the person's WAWA-fildlWEVIffiaRhat is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorde s office)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 correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature s roll ame)7 Date(month,day,y9ear).
Fufl resident address •
/ (number
o riid � -fond-ZIP code) L 3f)- 4 6�0 .
Person authorized by duly executed Power of Attorbey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street oily,state.and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.