HomeMy WebLinkAboutMortgage_Parke (2) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION'�".:, �" State Form 43709(R13/10-15) Q '125 r �1� ✓t ' Q
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HH=-• Presabed by Department of Local Government Finance "`r t
INSTRUCTIONS: • File Mark
To be fled 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 where the properly is County Auditor
boated on or before January 5 of the immediately succeeding calendar year. r] 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 additionalu instructionsM and qualifications.
Appd (owrrte r w con6a YaI - ^ 'res ` on sMp
lin Ci".
` rV/ion Page number
Ckb Taxing D !legal description RQCord_ 1 r 2-3 0 4—
Assessed 1e0 "On I. ZZ4- �23 L�(Vi
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortga /Contract indebtedness un id as of Is the nt the sole
assessment date,current year assessment date,current year date �J legal uitabte owner?
s OO Yes ❑ No
If no,what is his 1 her exact share of interest? If owned with ne other dtan'spouse,indicate with whom
If name on record is different than that of applicant indicate belwr e property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Hon (IC 6-1.1-7)
Name of mortgagee or contract seller11r�Cisk. .
Address of mortgagee or contact seller(number and athut city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage �� , I,)
Address of assignee(number and street city,state.and LP code) MAY 2 8 2013
Does applicant own property in any If yes,what county? What Taxing District? Has th' u • ested If yes,atdtd amount of deduction
other nty on
in Indanna? ❑iai Yes ❑No 01V J U AUglik5R
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contact 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 1 20 20 20 • 20 ' 20 20
Signature of Coon 1111 c1/ county
Date m
certifyI/dar u the penal perjury that the above and foregoing information a and correct and that the applicant- a resid nt of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signature( nets full rkanpe) Date(mama,der year)
6'12-
rricterddress
S .Vt Gvn my he andstree;ei stae-xV k pile)Si- 'i+G�
Person authorized by duty executed Power ofttort�\\orrbbyy7IC e-1.1--121-0.7 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$10,000.