HomeMy WebLinkAboutMortgage_James pa,� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
4 r- .• FOR DEDUCTION FROM ASSESSED VALUATION "
State Form 43709(R13/10-15) Iy1.)Q'�
- Presorted by Department of Local Government Finance IV1 v
INSTRUCTIONS: File Mark
Tb 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 property 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 Lowner or Yam gvyer- `c on reverse side)
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T Doll Key number/legal description
�T_ % 1� 1 10.o-001 . 61c --00 -1 2O1 `vq°29
Assessed valueof real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness un m as of Is the ptica the sole
assessment date,current year assessment date,current year date of a placation legal or stable owner?� 110 ()DO- Yes ❑ No
If r ,what is his/her exact share of interest? If owned with other then spouse,indicate with whom
If name on record is afferent than that of applicant indicate below a property in question:Annually Assessed
Real Property 0 AnnuallyAssessed
Moble Horne(IC 6-1.1-7)
Name of mortgagee a contract seller AA ''��11``
Address of mortgagee or contract seller(numt alld street ay,state,and ZIP code) FILE
I s .l
Name of assignee or other owner or holder of mortgage
O _ —
MAR 0 5 2019
Address of assignee(numberand a A V/ p � 3 t/ /
0
Does applicant own property in any Drawer NO am lassplaW lgriatte(tU[ny�Rate amount of deduction
other county sit in
-
in Indiana? ❑Yes ❑No urrent year? ❑Yes 0 No
A person is not entitled to this di r mortgage or contact indebtedness that is recorded in the county
recorder's office(including any 1 Card n O• orders office)that is the basis for the deduction.
MWn. l 'WW1 WM
Deduction approved in the amount of
20 20 20 20 20 ' 20' 20
Signature of County Auditor County Date(month,day,yea)
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 buyer of th aforementioned property on date application is filed.
Signature nets IuOrq!me) D(month,S-day,year)
•
JY`F�tdml/resident ad of a ' number curl$tree ay,state, code) 3 S \lQ1
1166 SV sow, // � On I-1-6 9-0 .
Person authorized by duly executed Power of Attorney or by 1C 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$10,000.