HomeMy WebLinkAboutMortgage_Reed (8) MORTGAGE
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, FOR STATEMENT
DEDUC OF
FROM ASSESSED VALUATION INDEBTEDNESS Countyu Township Year
State Fonn 43709(R13/10-15) Si- -IQ
` Presorted by Department of Local Govemment Finance my P at, I S O a O
INSTRUCTIONS: • File Mark
b 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 deduction is sought
Must be filed orposbnadred with the County Auditor or County RcrDfter of the county where the property is pQ County Auditor
located on or before January 5 of the immediately succeeding calendar year. /❑ unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
wh the property is during the twelve(12)months before March 31 of each year the deduction is(right
See reverse side dditional instruction and qualifications.
Applicant macnyer-see/a on reverse side)/
[j_ ,
! description R n r •Paep miler
/ , 01 0% zoo_ o% ,Sin- Dt./ O 0
value of t p \ Mortgage!Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
date�If'em y-- -_• \) assessment date,anent year date of application legal or equitable owner?
/� �(�� 0 Yes 0 No
If no,what is his/her exact -of interest? If owned with someone other spouse,indlrate with whom
If name on read is different than that of applicant,indicate below. Is property in question:Annually Assessed
Property 0 Annually Assessed
_ �r Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller �� ��>KA p
Address of mortgagee or contract seller(number and street,city,state,and e) 1A/(11r L - �
Name of assignee er orb i�. f /� -/a �rlr o'
l/.OJ, 3 . 77SAc Zois
Address of assignee(numb d street,city fe, LP rode) Gies }��_
Ory
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested _-IT ye�.4 )y anoint of deduction
inot Indiana?Indiana? ❑Yes ❑No cuon rrrent noperty torn year? ❑Yes ❑No rfOR
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 offnz)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20_ • 20 ' 20' 20
Sig:21Z Auditor _ County • Date(month,day,year)
I/We certify under the penalty of perjury Ztatfie above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
(, Signature(own name) Date(march,day,year)
Full resident addressof pplicant number and street city erg,and ZIP code) -/ ! 6(0
0/ 6 3kn✓f' iIltV/(9n �')) �ir✓e„,,,cOfe s
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12 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 half years and a fine not to exceed$10,000.