HomeMy WebLinkAboutMortgage_Miskell (2) V„ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEF
L s o Township Year
FOR DEDUCTION FROM ASSESSED VALUATION15 I -l9
State Form 43709(R131 10.75)
" Prescribed by Department of Local Government Finance MA 9 2019 MV P at, v 1 9 a
INSTRUCTIONS: • File Mark
lb be filed 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 dedur> rl
Must be filed or postmarked with the County Auditor or County Recorder of thtim(g pi 8(11p)pigpSrUa1TOR ❑ 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 0 County Recorder
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 qualifications.
Applicant march contract buyer- restrictions on reverse(
/ • \ tii
Tam rstrict Key number/legal description Record n Page number
an-1 a(0 02o - /3 - too - ooD. a y- o0 / ? 0 3/ 03
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year data of application legal or equitable owner?
a7 S a / 0 Yes 0 No
it 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 applicant,indicate below: Is the pupa xy in question:Annually Assessed
JSt-Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 6/3
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) ,H.846 Cc co
Name of assignee or other owner or holder of mortgage
Drawer No.( Qi t
Address of assignee(number and street,city,state,and ZIP code) '
Does applicant own property in any If yes,what county? Wnat Taxing District? Has this de Card 1\O• .... 10,
............
inother county an property y for
in Indiana? ❑Yes 0 No current year? ❑Yes U No i
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 fine of a'edit 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 4 20 " 204 20
Signature of County Auditor County - Date(month,day,year)
•
I 1 We certify under the penalty of perjury that the above and foregoing information is true and cones and that the applicant is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
//Sl �a Acumen f,j41/ Date(month,day,year)
,11\ r/i"4 �/�L/Ltia
u I resident address of applicant(number and street,city,state,and ZIP code)
dPi .f 7/00 a , ock/',0 C,'i- -0.1.t. `f7GA..
Person authorized by dutyexecuted Power of Attorney or by IC 6-1.1-1 0.7 Date(month,day,year)
Address of authorized person (number and street city,slate,and LP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.