HomeMy WebLinkAboutMortgage_Atkins a , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.t FOR DEDUCTION FROM ASSESSED VALUATION f.►'�'�p���� 9
:•-•-7i= State Form 43709(R13/10-15) B r),SV1 �
s ! Prescribed by Department of Local Government Finance LLJ/J/11 I,/ V S W
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed with:
Filing Oates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed orpostmarIced with the County Auditor 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 Ls sought
See reverse side for additional instructions and qualifications.
(ownerAPP Sf KIrI-s � CE1hin0.1
Tardn D" Key number/ description �,J / Rend number a number
� . �n - 11-2o —k -o0016 '{}- -DO- 2\11 %
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of ortgage/Contract indebtedne }unpaid as of Is the applicant the sole
assessment data,current year assessment data,anent year 4oafitscatia�_a •V"t legal or,�Qeble o neR/,t�p(�\)Yes ❑ No
If no,what is tits/her exact share of interest? If o netlme er than spouse,indicate with wham
If name on record is different than that of appfcant,indicate belrnr. 1 property in question:Annually Assessed
eau Property ❑ Annually Assessed
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V
Mobile Home(IC 6-1.1-7)
\� Name of or ccontractseller(-' cxsici _
Address gee or contract seller(number and street city,state,and ZIP code) -
Name of assignee or other owner or holder of mortgage F I L F,D
Address of assignee(number and street,city,state,and ZIP code) SEP 3 L019
Does applicant own property in any If yes,what county? nis dedu • n req ,state amount of deduction
other
in ? ❑Yes El No I"' - I s ai ryt n�rrr
A person is not entitled to this deduct- -•,on the person's mortgage or con Ttb}%recorded in the county
recorder's office(including any home ' .,.coded in the county recorder's office)that is the basis for the deduction.
• COUNTY AUDITOR
.Deduc on approved the a f.o in
•
20 21 J 20 20 - 20 20' 20
Signature of County Auditor t.1.....420C)
'n ,-.-tom/ CountyO 1 S Date( �°}"ye of
I/We certify under th. nal • of perjury that the abo regoing information S-Hne and correct and that the applicant rs resid nt of Indiana and
owner!contract buyer of the aforementioned property on date applicatio fled. /f
VS' (owner's tuOn n /u J Ol (44 04.4t.
(p Cte n_ ./�ya0//`\Full " tad t(nu /and any,state.a�code) /O ,"�j/
2-14 S t o�n _ (((((/////
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Person authorized by duly 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$10,000.
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