HomeMy WebLinkAboutMortgage_Howland a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
kt"—Zir FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
—' Prescribed by Department of Local Government Finance
INSTRUC77ONS: _ File Mark
To be fled 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
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year D 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 year the deduction is sought
See reverse side for additional instructions and
gnquaalifications. y
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T-.:r:�- Key number/legal description Record n r Page number
I/ 4 d /9/9-/o0r-ao. �3-ao36 tot oSa-8
"value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
nsevrnerd date,current year assessment date,current year date of application ���i1 legal or equitable owner?
r I ❑ Yes ❑ No
If no.what is his I her exact share of interest? If timed with someone oN than spouse,indicate with whom
if name on record is different than that of applicant indicate below. Is property in question:Annually Assessed
Real Property ❑ Annually Assessed
• �1�
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Pit �s[4
Address of mortgagee or contract seller(number and sheet cify,state,and ZIP code) �1
Name of assignee or other owner or holder of mortgage AP 3 O Z019
Address of assignee(number and street,dry.state,and ZIP code)
Glga pN �
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yCeligfa deduction
other county on property for ��vUUUIII OR
in Indiana? ❑Yes ❑No current year? ❑Yes ❑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
Signature of Auditor] /t County • Date(month,day,year)
I We certify under the penalty of perjury tITat the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
S' re( name) /1. h Date(month,day,year)
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Fug r address of applicant(number and sheet,city,state. d ZIP code) //
- 3 s � - S � d ._ c a � mil ( C 1 4.2 16- 'i.2 S-C
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 sheet 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. . - .. .