HomeMy WebLinkAboutMortgage_McCurry .. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'tt� . FOR DEDUCTION FROM ASSESSED VALUATION I
tl.. State Form 43709(R73/10.15) rrr111 ppp �� RAC
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S, Prescribed by oepaMreM oft �v.�: tce J rrr'YYY File Mark
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INSTRUCTIONS: J!To be filed in person or by mail. - filed with:
Filing Dater 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 immediatey succeeding calendar year- 0 unty 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 Mardi 31 of each year the deduction is sought
Se verse side for a '" al instructions and qualifications.
Ap0�wnerbaG r- re�on reverse sQph r
Texu District
tuber lC��(f`'_\descriptiq'rpl\� l�h' Record number a rum r
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpap�s of a the ' nt the sole
assessment date,current year assessment date,current year date of apptic io v ^ ^ (l-' legal owner?
UV 1Yes ❑ No
If no,what is his/her exact sham of interest? If owned with someone thar)ispouse,indicate with whom
If name on record is different than that of applicant,indicate below. property in question:Annually Assessed
Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgag ,or contract seller
4 c .n)Ohle0 0 � .
Address of mortgagee or contract seller(nu and,! -t city,state,a 21P code) '
Name of assignee or other owner or tickle • ca•-
•
Address of assignee(number and street city,state,and ZIP code) FILED
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been reqapiltEp 1 uy4Qe amount of deduction
other county
on property for
Yes ❑No current year? Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract in twine th eortled in the county
recorder's office(including any home equity line of aedit that is recorded in the county recorders office)that is ruction.
COUNTY AUDITOR GIBDON GOON IY AUDI fOR
Deduction approved in the amount of.
20 20 I—) 20 20 • 20 ' 20' 20
Signature of County Auditor � CountyO\ Date(nor n,d�yeaA1ram,
1,We certify under the pen o perjury that the above anndl/\o ng information is"N'uew and-correct and that the applicant is aaa resident of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
XSignature( e) Date( ,di yam)
RA r ddress d fiant(number and atyltate,and e) — _ ��
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Person authorized by duty executed Power of Attorney or by'Ct.t-12-D.7 _ Date(month,day,year)
Address of authorized person (number and street city,state,and LP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.