HomeMy WebLinkAboutMortgage_Lanman �4 ti, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�, .jo 4:0 FOR DEDUCTION FROM ASSESSED VALUATION
:j I State Form 43709(R13110-15)
b
As. Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. -Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is 0 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 ann••qualifications.
Applicant(o. eror ntract yer-see restri.i on reve •e
, if / G 42-0e....)
Taxi rs / _ Key n ber/lega descii lion Record num Page n
t.,./// 7 G76' o?-04 jdof-ekv. �3�=off7 0�0/ �d
Asses =;.-ue of real property s of Mortgage I 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 application �� legator equitable owner?
❑ Yes 0 No
If no,what is his I 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 e property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee contract sae �y� - 1, %/, ` • f
�(//KSC �/f. Y%a:[/�G�a. a ,�+�/ see-E.-xlacil..
Address of mortgagee or contract seller(number and s city, e,and£code)
Name of assignee or other owner or holder of mortgage FILE
fi
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 deduction been Ye�ueatez eayp,state amount of deduction
other county on property for
in Indiana? Yes 0 No current year?El Y 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgaggee r co i I-1:, b dne that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's73trl4W qt�s /y k;th deduction,
COUNTY AUDITORLIN) ALIrnTOR
Deduction approved in the amount of:
20 20 20 20 • 20 ' 20` 20
Signature of County Auditor County Date(month,day,year)
•
I/We certify under the penalty of perjury that the above and foregoing information is true a correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on da a application is filed_
Signs (owner's full name) Date(month,day,year)
Fu Ident address p'cant(num.e�d ,-et,city, e and d
X f I �G1..14_ / .. / 44767o
Person authorized by duly executed`ower of Attorney or 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 perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000,