HomeMy WebLinkAboutMortgage_Damon STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
1FOR DEDUCTION FROM ASSESSED VALUATION
; FOR
State Form 43709(R13/10.75) 01 �(�r/,��
�- Prescribed by Department of Local Government FinanceCW/ IOild "
INSTRUCTIONS: _ File Mark --
To be filed in person or by mail. F rm 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 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 rinduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or tract buyer-see on reverse side) I��
SGvol, 2)0-m n V �2 titvlc1 � l ✓d.1,
Tenthly D' t,Key number/MO description R n Page number
lu c\ (AS 1016 -14-1g -104 - boO 21 o-O03- , T 2158
Assessed value of real rty as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness un id as of Is the p' nt the sole
assessment date, assessment date,current year date U agpl O�� legal or astable owner?
0 No
If no,what is his/her exact share of interest? If owned with rue other plan spouse,indicate with whom
If name on record is different than that of apprirant,indicate below. l Is property in question:Annually Assessed
1 Real Property ❑ Annually Assessed
Mobile Hone(IC 6-1.1-7)
Name of mortgag contra
Address of mortgagee or contract_per( .•J ... .. - �U LP code)
Name of assignee or other own:!or - and MAY 31 2019
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deductio U y� of deduction
other county on property for
in Indiana? ❑Yes ❑No anent year? ❑Yes ❑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 recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in amount of
20 121(\a/ ��y/��y/�\ // 20 20 ' 20 20
Signature of County 1f % 1) Cornyr` Date(m s ear) i rtbc �. \ l�J QI1[ JV `lI/We certify under a penIty of perjury that the above and`foregoing information i,�le and correct and that the applicant is a s f Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signature s fu➢l a Date( ye
c,mot evnv-� �' l I
-- ant address pphpnt(numberand street city.state.and ZIP code) c
N rrt4 `n —9r b kcmA
Person authorized by duly executed Power of Attorney or by IC 5-1.1-12-0.7 Date(month,day.year)
Address of authorized person (number and street city,state,and LP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.