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HomeMy WebLinkAboutMortgage_Ferguson STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESSCounty Township Year •l' FOR DEDUCTION FROM ASSESSED VALUATION • : ] ��_-.:••. ; State Fomt 43709(R13l1415) 1 ‘311 i?•-T,A)S t� �\U S; .y Presor bed by Department of Local Government FinanceWe C // INSTRUCTIONS: File Mark To be filed in person or by mail. _ - v Fo filed with: Filing Oates 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought Must be Wed or postmarked with the CountyAuditor or County Recorder of the county where the property is County Auditor located 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 31 of each year the deduction is sought -_ - - - - See reverse side tot additional instructions and qualifications. Appliae s 1�4\rc_'\tee) • Taxing D' • Key ndrtlar r legal description Record number Page numbe Q- \ u) ?J -0c- 33 -3o0 -ono : 69 3 -0231 zoim 35Ok Assessed value of real as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment data,currant year assessment date,current year date f - legal a node owner? Yes ❑ No If no,what is his/her exact share of interest? If owned withsoftener than spouse,indicate with whom If name on record is different than that of appfi arm,indicate below: -, - property in question:Annually Assessed -It - ; ❑ AnnueOHo Home „I�1 Mobtle Home(IC 6-1.1-7) Name of mortgagee or contact seller, i r Wy\ Cy Mld - tVIC-9l Add of mortgageeorcontractseller(numbeiandstreetcity,state.and ZIP code) AUG 2 9 2019 Name of assignee or other owner or holder of mortgage )0(2Aµ',- ,�"*,q`^�'`/ Address of assignee(number and street city,state,and ZIP code) G I BSO N COUNTY AUDITOR Does applicant awn property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction Im�ndiaanna? ❑Yes ❑No currrenrnt year?for ❑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(nduding 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 20 20 20 - 20 - 20' 20 Signature of County Auditor � County 1- Date(m , ay,year) II We certify under the pena perjury at the above a regoing information is and correct and that the applicant is a ident of Indiana and owner I ntract buyer of the mentio property on date application is filed- XSlgnature Date(month,day,year)F dress of �A(A ��du street a7�poda) � /��/�� C " ) 1 'r— —orized by duty executed Power of Aitomey or by It;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$10,000.