HomeMy WebLinkAboutMortgage_Mason (2) i
n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township , Year
FOR DEDUCTION FROM ASSESSED VALUATION 1
y State Form 43709(R13!10-15)
y- id Prescribed by Department of Loca ove i t•ent Ma r - 4
INSTRUCTIONS: ' ' �.J File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Properly:Must be compl n.<•,,,i . I th''. .I da .r -a'r•• with', 1 te r:edu on is sought
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 I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
• where the properly is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for a ditionat instructions and qualifications.
'�nt(owner or con ye -see restrictions on rse
- 4 g Qistrict Key numberl/legal description Record num er Pa a numb r
hm�Y . �(—o( -rW --Zoo � )OO < g c.O -o t7- • 7_01 OLI -
Assessed vale real property as of Mortgage/Contract indebtedness unpaid as of Mortgage!Contract indebtedn_es,s unpaid as of Is the applicant the sole
assessment da e,current year assessment date,current year date ap I' tion W legal or equitable owner?
C�C ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned wi someone tither than spouse,indicate with whom
If name on record is different than that of applicant;indicate below: a property in question:Annually Assessed
Real Property 0 Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mo a e or contract seller \J V�fTJ 1 vl
FILEAddress of mortgagee or contract seller(number and street city,' e,hid ZIP code) 1,;
Name of assignee or other owner or holder of morgage
OCT 282019
Address of assignee(number and street,city,state,and ZIP code)
•
Does applicant own property in any If yes,what county? What Taxing District? Has this ded state amount of deduction
other county onp�g�r MIT
D I
in Indiana? ❑Yes ❑No cur ea o
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
1 COUNTY AUDITOR
Deduction approved in the amount of:
20 0 20 20 20 ' 20• 20
Signature of County AuditorTi--Y,,
61.)--y$=:::.) County (�y-\ orb , Date(mo ,day a rt
10
I/We certify unde he p Ity of perjury that the above and foregoing information is trffe and correct and that the applicant ant is a reside t of Indiana and
owner/contract buyer of e aforementionedP property on date application is filed.
rgnature owner's I name) D�te1 o�pr,� �e� •
yL�J l/lJ '(]i
u I resident address of applicant(number and dstreet, ity,state,and ZIP code) t
v t�s— E L1sl nl r-va,tns u-ovl - Li 6 4 .
Person authorized by duly executed Power elf Attorney or by IC 6-1.1-12-0.7 Dre nth, y r)
174
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.