HomeMy WebLinkAboutMortgage_Skipworth s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
- ,a FOR DEDUCTION FROM ASSESSED VALUATION . G
1„�' State Fonn 43709(R13t 10-15) 1 —1- w- m&it Wk I
�C4 -;,;ve. Prescnbed by Department of Local Government Finance \'\ W
INSTRUCTIONS: File Mark
to be filed in person or by mail. Form filed with:
Filing Dates' 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 where the property is County Auditor
located on or before January 5 of the immeJately 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 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
AeVnt(owner or contact buyer-3seeoScaons n reverse side) 1
Taxing District v Key nu t legal description Rend number Page number
en on owla 2 - 11 - 11 - N- o 0 — 03 Li vet 8 -oni 2n I a as--1 o
Assessed real of Mortgage I Contract indebtedness unpaid as of Mortgq I Contract indebtedness unpdd as of Is thei nt the sole
current date,current year assessment date,current year date application _-, W legal or ;title owner?
1; r y`aglf Yes ❑ No
If no,what is his I her exact share of interest? if owned with other n MW ,indicate with whom
If name on record is different than that of applicant,indicate below: II.property in question:Annually Assessed
Real Property ❑ Annually Assessed
�1 Mobile Home(IC 61.1-7)
Name oftee.. .. "a seller C���
A, , P_ lr
Address gee. 11 seller(number and t ,state,an e)�� FILE �1
Name of assignee or other owner or holder of mortgage
AUG 2 9 2019
Address of assignee(number and street city,state,and ZIP code)
. 4110,
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction peeq - u s':I• ir.l" . m gruction
other cos on C;1= Si' CUNt D T�EZ
in Indiana?y ❑Yes ❑No current year?a ❑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 line of aedit that is recorded in the county recorder's olfns)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved i amp t of
•
20 0 .JJ1/ 20 20 • 20 ' 20' 20
Signature of County • i (v)
County S� Date( ,-nfay ye1L( /,I 1 We certify under the penalty of perj above and foregoing information is to erjhd correct and that the applicant is reside t of�iana and
owner 1 contract buyer of the aforementioned property on date application is filed.
c4ture(owners tuo name) I ) Date( v � )l�
, p D A�ffif �� (/esid nta`d pp tt(nu/m,•, an•street st'a�te nitc1/4
—0 1 G3 Uke l `� IAA
Person authorized by duty executed Power 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 510,000.