HomeMy WebLinkAboutMortgage_Blanton a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Fonn 43709 tat 3/10-15) `n ���
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Presorted by Department of Local Government Finance r""'�l ?.
INSTRUCTIONS: File Mark
To be filed in person or by malt. Form filed with:
Filing Dates: 1) Real Properly 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 g County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) MobAe/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county County Recorder
where the properly is located during the hvelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
ne�e � n)
Taxing District Key number/legal description' �
assessment date,current year assessment current year date of rep ( legal on Me own
e(1
Zb-\8- -kQLtoO40 S�t7e� iYes ❑ No
If no.what is his I her exact share of interest? If owned with someori�other flan spouse.indicate with whom
If name on record is different than that of applicant indicate belor. I property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller SYLL Su C `) l , '
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage 1NL1 �e yn
�- MAY 2 2019
Address of assignee(number and street city state.•
Does applicant own property in any If yes,what a lrbon been requ EalvI ai amount of deduction
Bi�IMlacou? ❑yes ID No Drawer NO v ❑ Y •,(-)INTY AUDITOR
A person is not entitled to this deduction unles: it contract indebtedness that is recorded in the county
recorder's office(including any home equity lin Card
that is the basis for the deduction.
Car d NO.
Deduction approved in the amount of.
•
20 20 I 2�I 20 20 ' 20' 20
Signature of Cou dot dayDate(month, �� .
I/We ce ' er a penalty of perjury that the
a aaboovve an mg information id Mie 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. �J
Sxy Dale(month,tlarn
F re:2_,itet..address applicant(number and street.city statatZIP code
Person authorized by duty executed Power of Att&ney 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 haff years and a fine not to exceed 510,000. .