HomeMy WebLinkAboutMortgage_Kirby " STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
L :; FOR DEDUCTION FROM ASSESSED VALUATION ��
+ State Form 43709(R13/10. �(15)
Prescribed by Department of Local Government Finance t(9tt-
INSTRUCTIONS: File Mark
be filed in person or by mail. 'i
To .'` filed with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought MAY 2
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is ■ Co -ty Auditor
located on or before January 5 of the immediately succeeding calendar year. - I 1.1 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the ; it:, 4110i%•
where the property is located during the twelve(12)months before March 31 of each year the deduction'- ),(r •C •-
See reverse side for additional instructions and qualifications. OIBSON I"
Applicant(owner aCcllonsad buyer-see re\sbllclions on reverse side) �1����")J
C District \" umber legal n _ \r `� Record number Page number
wr• iNcei-on lQ - — \?l- ) - ()Q1 1-7-®0� , orb\ 1-U J—
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of I Is the applicant the sole
assessment loth,current year assessment date,current year date of application legal or equity owner?
Ill kpa0. ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of apprxant'udicate below Is the in question:Annually Assessed
Property ❑ Mobile y Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
E.] C11n S‘> > Re Te n ,n LLAAD ar A . a_
Address of mortgagee or contract seller(number and sheet,city,state,and ZIP code)
•
Name of assignee or other owner or holder of iinJi tyage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own properly in a If yes,what county? Wnat Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes No current year? ❑Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit 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
Sign�tute of
`
County_ AIudrt r
X . ry^ Date(month,day,yeQar)
I/We certify under the penalty of perjury that th abo d foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyout the aforementioned property on date application is filed.
Si ( n e) 1 , 'f Date mont C—
h,day, �a2LI r e ad ( u and l street,city,state,and ZIP code 'dvl'
80 9 +QA ry14-.0 Si..t W.�,.r.c-j-an. j• \-1-1 U510
Person authorized uly executed Power of Attorney or by IC 6-1.1-12d.7 I Date(month,day,year)
Address of authorized person (number and street dry,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a ha/years and a fine not to exceed 510,000. •