HomeMy WebLinkAboutMortgage_Lynn (2) trSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
:; FOR DEDUCTION FROM ASSESSED VALUATION �V1 `�Qp 200
State Form 43709(R13/10-15) cc'seil \ '�uJ� 1� Presatbed by Department of Loci(
the property is I'd County Auditor
located on or before January 5 of the immediately succeeding calendar year. iCounty Recorder
2) Mobde/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is boated during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Alt&Ire cot
stric8oeikins on�vwi
Taring D" Key number/legal ttobription o R number Page number
? 1 26 -11- 1U - 101 -GOO . 2,0 - - _ zo . 29g1 •
Assessed value of property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebted q
ness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of pI I n Q legal or owner?��(1j�o�p� \I 1 Yes ❑ No
•
If no,what is his/her enact sham of olMrest? If owned vita ere olhd than spruise,indicate with whom
if name on record is different than that of applicant,indicate below. Is property in question:Annually Assessed
cal Property 0 Annually Assessed
Mbbte Hurtle(IC 61.1-7)
Name of mortgagee or contrpipit SO I I _ I
Wi`�,M
Address of mortgagee or contract seber_number and street oily,state,and ZIP code) '
la
_ 4 FILE p
Name of assignee or other owner or holder c
Address of assigneetit,(number and street c+ r () / / 9 /
SEP 6 2019
DDoes nt own property in any If yes 1':111'C 1' Q uis deductionbeen state amount of deduction
other county
in Indiana? ❑Yes 0 No - It yeaR ,
A person is not entitled to this deductior Cat-cl NO Ors
pgebtedh6gesT is recorded in the county
recorder's office(including any home et_ - - �i )tfi�rs_the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the a .14 of
20 i 20 20 • 20 ' 20' 20
Signature of County Auditor 1/� County _\ _ _ ^ Date ,(lay, pA
I/We certifyunder the penaltyof u that the above and foregoing `Jcorrect a ' res. c"1 Penury eager information is true a d and that the is res eat of Indiana and
owner contract buyer of the aforementioned property on date application is filed.
F5 �enat frfr .
Ful adtlress o f a (n mbarand sheep sYdtD@ P"co
U — rV✓ l.°ki1�. , —b11- 4Th
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Person authorized by duly executed Power•lv•mey or by'iC 6-1.1-12-0.7 - Date,(n hth�+y ar)
Address of authorized person (number and street city,state.and ZIP code) `�/"'yY1IiL ��''LLVU II
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000,