HomeMy WebLinkAboutMortgage_Beasley (5) .. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
1a FOR DEDUCTION FROM ASSESSED VALUATION 9 Pad 2Ut i
State Form 43 (1 709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: _ File Mark
To be filed in person or by mail Form filed with:
Filing Oates: 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 property is W County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county � County Recorder
where the properly 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.
Applcant(owner or contactnbuyer-;_essrSobtrieverse
CeTaxing uistrict Key number/legal description Record number Page number
16 - o4-is--302 -00 0. 6 22-o20 Zo 1 ��1I do g 8 ._
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness yppaid as of Is the appll arltie sole
esspsement date,current year assessment date,current year date of pbptnn•ron v-- legal or uitable owner?
Yes ❑ No
If no,what is his/her exact share of interest? If owned with so eorte than spouse,indicate with whom
If name on record is different than that of apprcant,indicate below I e property in question:Annually Assessed
ea/Property 0 AnnuallyAssessed
e� I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ctC 1 T l 1� FILE
i,1 .
Address of mortgagee or contract seer(number and$tro d'y,state,and ZIP code) l(lF'
N.
Name of assignee or at L/' Q �J () APR 12 2019
�U / Si- T D 0 S
Address of assignee(ni .
oDoes ther applicant
t own pro Drawer NO o�this dedu getwesee y(eq;le5fP 9$ Jf deduction
in Indiana? ❑Ye_ current yeah for ❑Yes ❑No
A person is not entitle Card NO person's mortgage or contract indebtedness that is recorded in the county
recorder's office(inch, nunly 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
Sighs of Co fAatmuditacci.il .(c......0) 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.
Signatun ow ruff name) Date(mouth,day,yeark
Fur %&of applicant(number and street,city,state,and ZIP code) ,1 g
62 S c^ohkcon \4?ska — 3"
Person authorized by duty 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$10,000.