HomeMy WebLinkAboutMortgage_Jones (15) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-�`= _.s FOR DEDUCTION FROM ASSESSED VALUATION
•.' '' �':` State Form 43709(R13/10-15) 20 IC1
". -„�-',,,`/ Presalbed by Department of Local Government Finance
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 ID County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
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 for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
1-0.1r•a— J'Cr eCc.
g Distiict Key number!legal description Record number Page number
tuns\Tt lle r- lQ- l -1- 1. -ao to -clop•St?' - Caa 20 2 5+-3 .
Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
asca--Trent date,current year assessment date,current year daltof application Efl legal or equitatge owner?
. 41.- i Orn- { es ❑ No
If no,what is his!her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below. Is the ply in question:Annually Assessed
eal Annua(y Assessed
to Home(IC 6-1.1-7)
Name of mortgagee a contract sqffer
Si—cr\ t n.v - cd cA 0 >-12- -9- .\--,--sdii)1/4; .
Address of mortgagee or seller(number and street city,state,and LP code) ^p19
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Name of assignee or other owner or holder of mortgage L.:11 11 I l V. S�Tr� l
Address of assignee(number and street city,state,and LP coc j 0 / q _ 02 5 i 3 N rp,U301 OR
Does applicant own property in any If yes,what county? eduction bee u2` ed If yes,state amount of deduction
Imhndd iaa?y ❑Yes 5114; Drawer NO ar?r ❑Yes DNo
A person is not entitled to this deduction unless the perso e or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit; (� Oct)that is the basis for the deduction.
CardNL_:.. . .......rvn
Deduction approved in the amount of.
20 20 20 20 ' , 20 ' 20' 20
S' ature of County Auditorlair h Date(month,day,yegpt
it We certify under the penalty of perjury that th a . foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Si!.-, re(owner's fun na - Date(month,day,year)
..
F - t address. umber and street state,and ZIP code)
Jib ,
Person authorized by duly executed Power of Attorney or by IC 8-1.142.0.7 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.