HomeMy WebLinkAboutMortgage_Workman Y . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
• '} FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13110-15)
�—' Prescribed by Department of Local Government Finance 1
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed with:
Filing Dates 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 whe e 1 \ ❑ 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 " o t unty
where the property is located during the twelve(12)months before March 31 of each ar ' is sot
See reverse side for additional instructions and qualifications. n
Appfi t(overt or con ct -see on reverse side) `0" 1 B /
1 u; dt�ua Zr/Da�ar. /YC� J
Tr
,',,,/�,� Key number l legal description q�gde `n f1 n r
value •
Assessed assessment of
frureNy aso Mortgage/Contract yeard� ���pyMort.date�apI Coni act du np�f� sth or e
er?
`+P//r 000 ❑ yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that et applicant,indicate below-. Is the in question:Annually Assessed
eel Property 0 Annually Assessed
•
e or / �e 1 ��/� �n�a l/ Mobile Home(IC 6-1.1-7)
Norma mo g 0t 1 di / 2/4 i N/C 1
Address of mortgagee or contract seller(number and sheet dry,state,and ZIP code)
•
-
r/'•
Harm
1 Na of assignee or other owner of holder of mortgage
r
Pr
)I'. Addrs of assignee(number and sheet dry,state,and3�e)
rg AlVuL ,�f, 0%4i/11&kr/ l2/Vr '/7470
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 mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity fine 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 ot.
20 20 20 20 • 20 ' 20' 20
S' of County AUEitor Date(month,day,year)
i o/1/Zr_ t� L ih s/-1,2 -, '7-/S-i 9
/ I/We certify under the penalty of perjury that the a ve and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Si Cot hrti t\�Jt�, Date(month,day,year)
Ful r ad pp t(nu ber sheety sfale,a code)
/'I Al //�5n[/m/nladAt /gi n c state.
ti� -7L0 7D
Person authorized by duy executed Power of Attorney or by IC 6-1.1-12.0.7 Date(month,day,year)
Address of authorized person (number and sheet,city,slate,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.