HomeMy WebLinkAboutMortgage_Morrison STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
.'i `:'.- FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13110-15)
�- alb Presed by Department of Local Government FinanceF
INSTRUCTIONS: I _ File Mark
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lb be filed in person or by mail. Form fil
Filing Oates: 1) Real Properly.Must be completed and dated in the calendar year for whirl the deduction is sought.
Must be filed orpostmadced with the County Auditor or County Recorder of the county MAR tett&oWj is County Auditor
located on or before January 5 of the immediately succeeding calendar year ❑ County Recorder
2) Mobile I 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 eadr ye r>
See reverse side for additional instructions and qualifications. }QA
Appircant(ovmer or fractdryer-see on reverse side) GIHSUN UUUN I AUUI IUK
liti v / tin aid-Qrr/,rml
Taxing District Key number/legal desaiption Record number Page number
2/ -/2-// ' A/00 -UO/, 3 S- 627
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assess-nent dad,current year dge,acre/g�(ye-ar- to of application legal or equda owner?
ern. /v a/t-k-- /3 J, coo Yes 0 No
K rro,what is his/tier exact share of interest? If wined with someone other than grrurso,indicate with whom
If name on record is different than that of applicant,indicate below: Is the in question:Annually Assessed
cal Property ❑ AnnuallyAssessed
�^mortgagee or t (� �y �/ • y(.1(/_y_��,�/�y.,t//� r 1� .Mobile Home(IC
6-1.1-7)
Na/4JL 4/A'L / -. ei//N✓ , lu 4aQs 71�r�'[J VW.-.V' )
Address^r'{',-,",'w-gagee or contract seller(number and street city,state,and LP code) A I3C C.�•({�I ,pry
/ Name of a$iiggLnee or gt(r9(ywner - mortgage ® Drawer N O.ti-r O I _ -
//y\_,Address of'2igne0(((nnrlummbber�s t city,state,and 21-code) 895
}� 2/zz. f ITr6 Card NO.
Does applicant own properly in any If y-- what coun . Taxsg District? Has this deduction been requested If yes,state amount of deduction
in�Indiana?nty ❑Yes 0 No �,97L.i� aairren r?r ❑Yes 0 No
A person is not entitled to this ded ,.,'r n unless the •-rson has a balance on the pe n's mortyaye or contact indebtedness that is recorded in the county
1matter's office(mcluding any home -•ulty fine of. -•it that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 • 20 ' 20' 20
Sig�na�N/fie of County Aud' County - Date(month,day,year)
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�NllAT 19, i /G
I/We certify under the pen- ty of perjury' at the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the efvremen 1• ed property on date application is filed.
Signature(owner's hill name) Date(month,day,year)
Full resident address of app (number and sheet,city.state,and ZIP code)
1
Person authorized by duly executed Power of Attorney 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)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. I - n