HomeMy WebLinkAboutMortgage_Harmon (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS '
� County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION rry N a-'.- I k ao
y„ ' State Form 43709(R73/70.t� t
Presabed by Department of Local Government Finance
INSTRUCTIONS: 111�� g���..1JJ ile Mark
ki be filed in
Fillitg Oates:1)son or by Rea Property:Must be completed and dated in the calendar year for which the deduction is sou 1Y 8 2019 Form filed with:
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.
/ i 2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor. ,.. . County Recorder
where the properly is located during the twelve(12)months before March 31 of each year the.-.h.-•j' k-� !�• —
Record number Page number
c24 -17 -05 - gob - 000. 7 9G - 00" raj 9 Si /
Assessed of real p as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment surer¢ assessment data,current year date of application legal or equitable owner?
II `' OD ❑ yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than xe,indicate with whom
If name on record is different than that at applicant indicate below Is the property in question:Annually Assessed
eatPtopeity 0 Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee a ct seller
Address of mortgagee or ct seller(number and street,city,state,and ZIP code) '
•
Name of assignee or other owner or holder ofmortgage �- _ __
aln
Address of assignee(number and sleet,city,state,and ZIP code) ,� -
' llra11e� t\t'JG2�.
Does applicant own properly in any If yes,what county? What Taxing District? Has O•. Coon
on t
0.I.-r........
other
❑Yes 0 No a air
A person is not entitled to this deduction unless the person has a balance on the person's m Ca I.(J No. g" - a county
recorder's office(including any home equity line of credit that is recorded in the county recce
COUNTY AUDITOR
Deduction eppruxed in the amount of.
20 20 20 20 , 20 ' 20' 20
Signature of County Auditor /4� / County • Date(month,day,year)
I/We certify under the penalty of perjury that the above a ongoing information is true and correct and that the applicant is a resident of Indiana and
owner I contrail buyer of the aforementioned property on to application is filed.
Signet... (owners fug name) Date(month,day,year)
tc,
`, 7 till resident address of applicant(n bet and street,city,state,and ZIP code) �1/ /
lf. /C O/V(v SS I)> D✓ ea, j, //F wit./ i-1 /Sc t7C
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,slate,and ZIP code)
The penalties for perjury can include imprisonment up to Iwo and a half years and a fine not to exceed$10,000. -