HomeMy WebLinkAboutMortgage_Logsdon (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
.j '" FOR DEDUCTION FROM ASSESSED VALUATION County ITownrs1h�ip �Y(e�ar/�.f State Form 43709(Rl3!10.15) c Y \"i . 2CIV 1
"--- Prescribed by Department of Local Government Finance ���JJJJ
INSTRUCTIONS: _ File Mark
To be filed in person or by mail. Form filed with:
Filing Dates 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 Courtly 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 Properly:Must file with the County Auditor of the county
where the property is bca a bveAe.(12)months before March 31 of each year the deduction is sought
See reverse side for additional in ' s and qualifications.
Appeya\e-t or5tract toyer- "ons on reverse side)
�N"n N 1,Vr\ Vek 44.1/4).,. • .
Taiping Dis,ist L.) t legal Remrd nu Page number
O01 . 204 -02} . 70� I{ �
Assessed value of real pnq,c,ty as of Mortgage!Contract indebtedness unpaid as of Mortg ge I Contract indebtedness unpaid as of Is the applicant the sole
xcxcment date,currant year assessment date,current year date 111"""���� cN legal°Oo(e5151oitable owner?
„0— - DO Yes ❑ No
If no,what is his I her exact share of interest? If owned wi someone piper than spouse,indicate with whom /J�,
If name on record is different than that of applicant,indicate below • I -perynsty in question:Annually Assessed
7 Assessed
�\ �,. Ann'� ❑ Mobile Horne(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(num and street city,slate,and ZIP code) 2019
JUG--0 2
Name of assignee or other owner or holder of mortgage
pil
Address of assignee(number and street city,state,and ZIP code) 1
3i OUS" PUp1TOR
GIBBON
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes El No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's morlyeye 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 the amount of:
•
20 OF 0 20 - 20 ' 20' 20
1! c
Signature of Count'Au-- • / wl 1 ,( County �� Date(month,day,yeas
,1/�I (1E1Th►ter
1/We certify under the penalty of perjury t the above and foregoing information and correct and'that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owners MI name) Date(pont/i,qay,Y
yl.. N- A wa_1 „. ) /f]I/ TIZ l l/\.{.4,
esident ad of t( bar and t citystate,and ZIP e
01 2,L.S-� � �,-,zn- `ice
Person authorized by duty executed Paler of Attorney or by IC 6-1.1-12-0.7 . Date imimp,d }gar)
Address of authorized person (number and street city,state,and ZIP sects)
L (_A\
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.