HomeMy WebLinkAboutMortgage_Johnson (35) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
^�r tee`'' FOR DEDUCTION FROM ASSESSED VALUATION County ry�T`orw`tnrs�hiAp 1Yea`r(3
State Form 43709(R13/10.15) \v_ 1 1.:> \ Ol-1
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PresrYbed by Department of Local Government Finance
INSTRUCTIONS: • File Mark
To be filed in person or by mail. Form/led 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 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 leerily deductkin is sought
See reverse side for additional instructions and qualifications.
Applicant or conlraa buyer-se fictions on reverse side)
�1 S Jamct Key_ _
T "1of` U\. zZ ei<�-tO2-oo o . � 02-3 R20\number �Oge '4-i-- .
Assessed value of real property as of Mortgage/Conrad indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,cement year date of ap ,ion legal or 'table owner?
Yes ❑ No
o,If n what is his I her exact share of interest? If owned with �ottler O spouse,indicate with whom
If name on record is different than that of applicant,indicate below-. property in question:Annually Assessed
Real Property 0 AnnualyAssessed
FILED
'.Y�fl�pA Mobie Home(IC 6-1.1-7)
Nacredrrtgagee or contract seller C t It It,nk , �1 JLJ �✓
Address of mortgagee or contact seller(number andd sleet city,state,and dAZIP+ -code) g 33LL
Name of assignee or other or--_.--`-"-- .
Address of assignee(number r2-d/ 9 o g 7 APR 9 2019
•
Does applicant own properly Drawer NO Has this dedu -
fop1 r; p4C I state amount of deduction
other
Indiana? ❑Yes I aoeirrent . ti Yess U Li NoAJUIYOR
A person is not entitled to: axis mortgage or contract indebtedness that is recorded in the county
recorder's office(including Card NO. l recorder's office)that is the basis for the deduction.
Deduction approved in the amount of
•
20 20 20 20 20 ' 20' 20
nre 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(owner's full name) Date(month,day,ye
/y\ `t3�,;, s • ,,,,_C4},-. ��/( /� f y •q• lit .
Full resident address q1� S of n(_, "1 tt 1 /1rd ZIP code) 491�o
Person authorized by duty executed Po4er 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$10,000.