HomeMy WebLinkAboutMortgage_Patterson �.- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION \ \
�-'� State Form 43709(R73/10.16) 1\_.�./�- �\ 9Y-t'G
Prescribed by Department of Local Government nce EEEyyy a v
INSTRUCTIONS:
action is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county County Recorder
where the properly is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side(Or rad�di-tional instructions and qualifications.
resirs en raw).f_son
number/legal w�on Re df\artnCJber Le V -
2�-Z� -U?5-Soo -op2, Th3$ - O2U "cord
tI
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/ tract ieir?tedness unpaid as of Is the applicant the sole
assessment date,current year assessment cafe,current year date of ----�� legal or equitable owner?
❑ Yes ❑ No
d no,what is his/her exact share of interest? If owned with ne other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below Is the property in question:Annually Assessed
0 Real Property 0 Annually Assessed
1 ) Mobile Home(IC 6-1.1-7)
Name of ee ncanh�a serer \ air_ L FILE .
Address of gee or Y:Jseller(number and abeet city,sta ,andw 1➢^P`code) I,
Name of assignee or other owner or holder of mortgage AU 6 5 — 2019
Address of assignee(number and street city state,and ZIP code) l!,��RRqq((11 tN,In((r�r1��trimr1��tvlTy ��1 f�I�T(��rr'tt
Does applicant own property in any If yes,what county? What Taxing District? Has the air aoulJhhltfaEn requested'9T1c atate amount of deduction
other county on property for
in Indiana? ❑Yes 0 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 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 20C
'/t 0 20 • 20 ' 20' 20
Signature of n rtor YH�0 County Datetr d aqi
I/We certify' r the penalty of perjury tha a above and foregoing information is true and correct and that the applicant is a4esid nt of Indiana and
owner I contra mentioned property on date application is filed.ii ///]]]
Signawre( bra ram Date i
dim,
F t of t number and set city state,and LP code)
4 j Zo o �/ H `tr cb-t )n
Person authorized by duly executetl Paver of Attorney or by IC 6-1.1-12-0.7 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 810,000.