HomeMy WebLinkAboutMortgage_Rodgers (5) . ;�►a, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
:..; FOR DEDUCTION FROM ASSESSED VALUATION
-,'` State Fonn 43709(R13/10-15) l
`° ,.id Prescribed by Department of Local Government Finance INS\W\ ?oco kvl `9 t
INSTRUCTIONS:
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 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.
Applicanwaer or contract see sfrictions on reverse side)
e
min Di 'ct K n ber/legal description Record number P
26 —2 101-00 0 310 2 —020 'ZO1 �3 6.
Ass sed va ue of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of a lice'oaf legal or !table owner?
0C)LI • Yes ❑ No
If no,what is his I her exact share of interest? If owned with so One er thpn spouse,indicate with whom
If name on record is different than that of applicant,indicate below: r I e property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1 7)
Name of mortgagee or ct seller- ^ li v
I
1`v� J
Address of mortgagee or contras Iler(number and street city,state,and ZIP code) - FI E
Name of assignee or other owner or holder ofDi ic S E P 19 2019
Address of assignee(number and street;city,
Does applicant own property in any If yes; Drawer NO........ .I its deduc�g g(fIq� NTINy�Lif Tab�int of deduction
other county party for
in Indiana? ❑Yes ❑No - � it year? ❑Yes El
A person is not entitled to this deductior Card NO. 3 �Kt gage or contract indebtedness that is recorded in the county
recorder's office(including any home ec. _ • Ir's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 i CT 20 20 20` 20
Signature of County Audito- County Date(month(day,,yeI/We certify under t .e alty of pequove and foregoing information is r e and correct and that the applicant is des e t of Indiana and
own- I contract buyer of the aforementioned property on date application is filed.
ign- (owner fun nam Date(month,day,year)
Full.- ids/t address of applicant(ner and street,city,state,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12•D.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.