HomeMy WebLinkAboutMortgage_Rains (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
. atbFOR DEDUCTION FROM ASSESSED VALUATION County Township Year
State Forth 43709(R13/10-15) ao1G
Presed by Department of Local Government Finance �`r � -�
INSTRUC77ONS: • File Mark
lb be filed in person or by mall F rm filed with:
Filing Dater 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 when:the property is County Auditor
kr=ted 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 3f of each year the deduction is sought
See reverse sidesi or additional instructions and qualifications. `�/,,
Aprejnowner
ntract,buyer-le._stnroovnLenrse side)
eij
Taxing District m1 ! tlesai \\\ R hum Page number
2 -1 ---1 -7or) mod - SSX _ 0 �� • er°lt 423-3
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment dale,current year assessment date,wrrent year date of ppr 0legal or, currier?
0 D O • Yes El No
If no,what is his/her exact share of interest? If owned with some othe/than spur'se,indicate with whom
If nameon record is different than that of applicant,indicate below. 111 Is property in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or con�^ ��� ��
l l"'\
•
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or hol
0i 0 /& ` 'tl.
c?)-- 5 3 JUL 1 8 2019
Address of assignee(number and sires nn//
• Drawer NO X1
Does applicant own property in any Hastafi striD Jf yrzs,state amount of deduction
other county on property for 1 U Ft
in Indiana? ❑Yes LINO current year? ❑Yes 0 No
A person is not entitled to this dedr Cat () N O• :mortgage or contract indebtedness that is recorded in the county
launders office(induding any hoc... . . - - corder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 • 20 ' 20' 20
Signature of County Auditor ( `( County Date(m a L�f )mow IL
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a ide t of Indiana and
owner/conirad buyer of the aforementioned property on date application is filed.
Signatu s full name) Date(urrwnh, �ax,y /a
A � 1 .
WI resident address of appfrcannftt(numbbeer and
f state.
and ZIP
code)L,J` / q�-,(,J
Person9> 2_ by dutyexecuted Pourer of Atmrner by — ✓' 1 1}Cl r
a IC e-1.1-12477 Date(month,day,year)
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 510,000: -