HomeMy WebLinkAboutMortgage_Quinlin (2) sa STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. FOR DEDUCTION FROM ASSESSED VALUATION �'^
','.' „' State Form 43709(R13/10-15) J�\ l 1.7c ` au�.t
S .y Prescribed by Department of Local Government Finance ��� l
File Mark
INSTRUCTIONS:
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 tf CountyAuditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the i0.„rediatey succeeding calendar year. /0Q 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 o1 each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant,, 1(owner or contract buyer-see restrictions on reverse side) ,
evt A- to c_fi1ar., 0uinh \
Taxing District� n Key number I legal desdription Recoil number Page number
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Assessed value of real property as of - Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,and year assessment date,current year date� 6 1 1( 1 CO / legal wO Yes ❑owner?
No
0 no,what is his I her exact share of interest? If owned with'someone other-than t )spouse,indicate with whom / 1
I If name on record is efferent than that of applicant indicate below:below: rls the property in question:Annually Assessed
❑r Real Property ❑ Annually Assessed
r( Moblle Hoare(IC 6-1.1-7)
Name of mortgagee or contract seller Qx 1 ��cy0�(� ( /� r I
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage _
- atol I ` oSI `�
Address of assignee(number and street city,state,and ZIP code)
N ....O.........
......
DDoes ares appplicant own property in any If yes,what county? w Is,1 ,state amount of deduction
in Indiana 1-1
❑Yes ❑No DlDrawer ••••,,A person is not entitled to this deduction unless the person has a bat Card rat is recorded in the county
recorder's office(including any home equity line of credit that is moor , _...,....ea uasrs tot the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
•
20 20 20 20 2 20
Signature`of County Auditor County • � month,day,year)
,S\at►. •Sry \`''\(/ _� CAI bJ0r. C 2 —2-—ICI _
I/We certify under the penalty of perjury that the above and foregoing information is true and cordailictih&tfg}flplicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
k —Signature(owner's kill name) ginonth,day,year)
Ox- ts'77-74 --"' " et 4 OfB�Ory t,V U TY AUDITOR
2j _ t'i
,
Fug resident address of applicant(number and sheet,oily,Yale,and ZIP code)
S U S Rtkouv .s Sp 0'11'1'\ .e N ` %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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.