HomeMy WebLinkAboutMortgage_Dove (2) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' FOR DEDUCTION FROM ASSESSED VALUATION rr���i
T' State Form 43709(R13 110-15) v „c N �ri . Z0 1 q
Presatbed by Department of Local Government Finance �•.�
�I _ File Mark
INSTRUCTIONS:obefilidin $ 12„ - M�, • Form filed with:
Tobe filed person orby mail ` l
Filing Dates 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or posbnarked with the CountyAuditor 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 Mann 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Apittruit(owner or coma see on reveres srdeip},.,
4P(E,�q �� Se� S/lJ`r� r� �f
Taxr� ` ^ Key �\Z -Sol �ov 2-0` - . Record nu r Page rum r
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of -applicant the sole
assessment date,aurem year assessment data,current year dad d ication co itable owner?
gp� Yes ❑ No
If co,what is his/her exact share of interest? If owned wtomeorb other than spouse,indicate with whom
If name on record is different than that of applicant indicate below-. Is .- property in question:Annually Assessed
I, - Property ❑ Annually Assessed
Noble Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Satt-
Jv lOn L. F' II' E D
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
MAY 21 2019
Address of assignee(number and street city,state,and ZIP code) A it
�tggrlN COUNTY AUDITOR
Does applicant own properly in any If yes,what county? What Taxing District?other Has this deduction been requested If yes,state amount of deduction
in Indiana? ❑Yes ❑No on
�n ❑Yes 0 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 a in the amount of
20 20 a I 20 20 • 20 ' 20' 20
SignaNre o ry �rv����/I_ County ^ Date( ,day,l I
I/We certify under the penalty of perjury that the above and foregoing information is and correct and that the applicant i a resid nt of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
CT -(•-nets fugal e) /1 Date(m y ye ci
•
NO • //U((/.6��jVL- — f(S—
I resident address p t(number and sheet,city,state,and ZIP code)
231 S Os\1 v ? `ivnr 1n — 4+-6IQ
Person authorized by duly executed Power obeftmey or by 1C 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet 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.