HomeMy WebLinkAboutMortgage_Chapman (3) �.� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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::g FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15) r� �,r� f. Z�`A
`°� -d Prescribed by Department of Local Government Finance J ' I
File Mark
INSTRUCTIONS:
To be filed in person or by mail. F led with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought
Must be filed orpostrnarked 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.
Applicant(owner or contract buy r-see restrictions on reverse side)
13►11 �4^" 1-1‘ wNcJlr
Taxing Dist Key n er ai description Record numW Page number
f - Tw.s• f it,-Os-2-1-3o0_fl 00 . 2 Ll-0'2,•-9- 20 19 14 04
Assessed value of 1 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 pplication W legal• e•r-itableowner?
� S 000 Ir. Yes 0 No
If no,what is his/her exact share of interest? If owned with s meone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is e property in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee oorr ontract seller 1 la)1l GG 1\�JIJI•�`oivaFIL .:_
Address of mortgagee or contract seller(number and street city,state,and ZIP code) �4Name of assignee or other owner or 0 ( 9 - / O LI . -' ,
OCT 2 5 2019
Address of assignee(number and s
Drawer NO nn •
Does applicant own property in any Has this deduction bee state amount of deduction
other county on property fo6I QN y Y AUDITOR
in Indiana? El Yes El No Current year? LI Yes o
A person is not entitled to this d Card 1\r O. rrson's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any t _ rnty recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 2; 20 20 20 20• 20
Signature of County Auditor County Date mon ,day,ye r)
,,i....)
I,We certify under the pena ri7• •erjury that the a ve and foregoing information is true and correct and that the applicant is reside t ofjndiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sign-_ur: (owner's full e) Date(mot,day a
Full resident a•-,. -ss of applicant(num and street, " ,state,and ZIP code)
2 clikk.k C- Thea►_I IQ f l lvn - c- uiR-6 )
Person authorized by duly executed Power of Attorney Sr 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 oeriury can include imprisonment up to two and a half vents and a fine not to exceed 510_DOD_