HomeMy WebLinkAboutMortgage_Julian .. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
..f - FOR DEDUCTION FROM ASSESSED VALUATION } l 1
�:• State Form 43709(R13/t0.75) !'{l�„c.�_ YI leOf 1. 2oF7
Prescribed by Department of Local Government Finance J«..tt..77��77 �\ ' 1 J'r V"V l Ol (1
INSTRUCTIONS: File Mark
b 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 r0'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.
AN:4 n(pwner or (iact Oyer-see restrictions on reverse side)
Tadnri' \/\ K ,t n-g4oR.,„—oo2.2c�r -o24 . Record numberPage number
r�%, ilvV V S201 23
A�s•¢d value real propel,/as of �^ Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness gyaid as of Is the ap the site '
assessment date,anent year assessment date,orient year date of ap V legal or @5 uxable owne .
yr��t Yes 0 No
If no,what is his I her exact share of interest? If owned with ne other yen spspto,indicate with whom 1
if name on record is different than that of appliiiant,indicate below. P he property in question:Annually AM44sP4
Iii Real Property 0 AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Named mororcontactselIer 1��1n'IF{I-rI{
—PM
Address of mortgageemri seller(number a e4 CI};safe,and ZIP code) T■
Name of assignee or other owner or holder of mortgage g���
Address of assignee(number an, 4 0/ R _ /7 ° 3 JUN 27 2019
Does appppli t own property in a Dr a 1Y C I NO H this on ho t equ�d ,state amount of deduction
in Indiana?unty ❑Yes ❑h anent year?or ❑.1 m1 -f, AUDITOR
A person is not entitled to this • xrn's mortgagee t WiThkedness that is'recorded in the county
recorder's office(including an, C a t'd NO. ty recorder's office)that is the basis for the deduction.
COUNTY AUDITOR •
Dedotlon approved in the amount of
20 20 20 20 20 ' 20- 20
-S to of nty,Qltdit•� ' . County Dat0.( iqar)
r artily under of perjury that the above and foregoing information is true and correct and that the applica t is a ident of Indiana and
l own contract b r of the afore rn///e da4 property on date application is filed.
StgnaWrd outs 'p, /"'CYC Datelfn �7F yeah
� SSN
F24 taddress of� Wp 11(number and street city,state.aad ZIP code)
o cs)j VV Ft iJbOrtkh V1 . p/7I I_L1
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 ' Date
6rtiree .
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 S10,000.