HomeMy WebLinkAboutMortgage_Harpenall STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
s�-: FOR DEDUCTION FROM ASSESSED VALUATION County Township Year
-
x_�=i - Slate Form 43709(R13/10-15) �j l \A /�G
Prescribed by Department of Local Government Finance J V �\/L)I Il
INSTRUCTIONS: File Mark
To be filed in person or by mail. F filed with:
Filing Oaten 1) Real Properly 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 sought
See reverse side for additional instructions and qualifications. 'I a
ftsr)Pirti ew weta�va 1e on se cede yr -
Taxing District tuber/ al desai r�- '1./,t R nu Page n r
-2 � z=3 „to?
tOr-C22-�^ . Ric;
r 21 b .
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as ofongage Contract indebtedness unpa' f Is the applicant the sole
assessment date,current year assessment date,current year te of n`..�--`!!!''^^^ r'� J_ legal or equitable owner?J.J ���,J r 0 Yes 0 No
If rm,what is his I her exact share of interest? If owned with eone other than souse,imiicate with whom
If name on record is different than that at applicant indicate belay. Is the property an question:Annually Assessed
•
St Z 1 0 Real Property 0 AnnuafiyAssessed
J, /— Mobile Fiortte oC&,.,-7)
Name of mortgagee or contract seller V � 11
Address of mortgagee or contract seller(number and"beet,city,state,and ZIP code) ILE `,1 '
Name of assignee or other owner or holder of mortgage )
Address of assignee(number and street oty,state,and ZIP code)
JUN 2 61019
Does
cant own property in any If yes,what county? What Taxing District? Has
this deduction bee r nt of deduction
in other county na? ❑Yes ❑No current year?oPellY fornprilMN Y Al)D11
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(induding any home equity line of aedit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
•
20 20 20 20 - • 20 ' 20' 20
c ' I
Signature of dQcy . )—}-( ��/1 \ County I kM10 Date(m desr)�
II�IAjkAC Jti (`�'V\,C7 /1 Ili/�J 1l t
I/We certify under the penalty of perjury that the above and-foregoing information is and correct and that the applicant s a res' nt of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
K: rt;te.
Ml name) Date y d eO` i and ZP ^- 1 1
Person authorized by duty executed Power of Attorney or by id e-1.1-12-0.7 Date(m� ,fdai;yr)
Address of authorized person (number and street city,state and ZIP code) b C._b II
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. ,