HomeMy WebLinkAboutMortgage_Allen (2) �,: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun�y Township Year
re' -<t7' FOR DEDUCTION FROM ASSESSED VALUATION ,(,—.�1,_, Q�,� (�
State Fonn 43709(Rr9rtats) �N'r Y1JUn �J'^'On Z0� 1
s) Prescribed by Department of Local Government Finance
INSTRUCTIONS: • File Mark
To be filed in person or by mail Form filed with: • -
Filing Oates 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. 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 sough/
See reverse side for additional instructions and qualifications.
Applicant(ow., or con d mstricWns reverse side)
r v� - 4- X7iIt W0. a,lt
T-.: . s';,12. Key number/
legal desaippon Red number Page
-, ot[�gVg" voa- col my-o, 42rdd!/ !e— m
.
value of real Mortgage indebtedness Mortgage ror indebtedness unpaid rIs the a applicant the sole
:7- roam dale,cunent year assessment date,current year date of ape/ay n I legal oi • owner?d r/& -Icf7. 00 Yes ID No
If 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 property in question:Annually Assessed
Real Property ❑ AnnuallyAssessed
• !!!!!! ��`��` (� ` Mobble Horre(IC,66-1.1-7)
Name otmongag�wcanuat►s`�e�'cep_A1j'L!� tt ReSe f Lie
I /'+ I \i _{l �S alik k0 b'r `OOPS
Address of mort or contrail seder(nLn1 and state,and ZIP code)1 `l l.r �t eJ
• v7f /01- /O �iget -
Name of assignee r owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) IF'I M. E D
Mat
Does applicant own property in any If yes,what county? at Taxing District? Has this deduction beenrregsted- If yes,state amount of deduction -- --
in�Indiaanna?y ❑Yes ❑No cement $4fSW't p 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 recoiled in the county recorder's? , they is thd-besslbr the deduction.
COUNTY AUDITOR • Imo.
D approved in theamountct GIbSON COU.4T'( A. DITOR
20 ,¢�f 20 20 20 • 20 ' 20' 20
Sig`igfS inty Aud /7`si County • Date(month,day,year)
I/We certify under r the penalty of perjury that the 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.
b
% Pull en� 1 applicant(number and street state.and Zl code), ,� /�r� '
3
At
au hndied by duly executed Power ofu )Attorney or by IC 6-1.7-72-0.7 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 half years and a fine not to exceed$10,000.