HomeMy WebLinkAboutMortgage_Nathan p STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
44 FOR DEDUCTION FROM ASSESSED VALUATION (��c iIfn (�Y!1
State Form 43709(R13/10.15) CbSon r 1_ r _ 'vy /N f 1
Prescribed by Department of Local Government Finance J
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 rrriiirrr
Must be filed or posbnarked with the County Auditor or County Recorder of the county where the property is t� County Auditor
located on or before January 5 of the immediately succeeding calendar year. �1 County Recorder
2) Mobile I Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county
where the property is located during the hvehre(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(ahv�conrn r buyer-see on reverse side)
strict
Key nu /Mraesi
T c_ ,o-n� — l 1 4-102 600 - I�— VZ" Record number 2 �ge numW,
tn'_1
Assessed value property as of Mortgage/Contact Indebtedness unpaid as of Mortge e/Contract indebtedness unpaid as of Is the applicant the sole .
assessmentassessment date,current year date,enteric year datep jpn O 00
W legal dr unable owner?
�i I) Yes ❑ No
If no,what is his/her exact share of interest? If owned with ne other than douse,indicate with whom
r If nameon record is different than that of applicant indicate below: Is property in question:Annually Assessed
Property 0 AnnuallyAssessed
1 Mobile Home(IC 6-1.1-7)
Nance of mortgagee or contract seller SU % I ` 1 v Qom,`1 ar 10
Address of mortgagee or contract seller(number and .state.and ZIP code) _ .
Name of assignee or other owner or holder of mort Address of assignee(number and street,city,state Dl i W C I' NO '9O 1? FILE i,!
Does applicant own property in any If yes,what. .`I 13 uction beenitslirtid 1 IfxycMstata amount of deduction
in Indiana? ❑ - h DNo CflI'v NO. or ❑Yes ❑No Lt11y
A person is not e r ed to this ded ale the person has a balance on the person's mortgage or contra debtedness H�aUters�recorded in the county
recorder's office(i trig. y home eq ' li e of it this recorded in the county recorder's office)that r.Cl uction.
t COUNTY AUDITOR
'nBSUN COUNTYlAC1UDITOR
Deduction approved i . e
1
20 t_ 20 �2/01 20 - - 20 ' 20' /'� 20
Signature of County Auditor ��1 l` \ County - Date(mddh, t c
I/We certify under the penalty of peg the above and foregoing information is true and coned and that the applicant is id nt of Indiana and
owner I ntract buyer of the afore ntioned property on date application is filed.
Sig fullname) Date(m ay, e
Full entatl t(number and sfreet i te,and Pcode) r
:fin S aT�
Person authorized by duly executed Power Attorney or by IC 6-1.1-12-0.7 Date(month,day,yeah
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.