HomeMy WebLinkAboutMortgage_Brownell (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-„Alh FOR DEDUCTION FROM ASSESSED VALUATION 3\30,„. :,, ` State Form 43709(R13/10-15) \ ` 20\9
-„', 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 properly 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 properly 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.
Ap lic art. owner or con ct b ye -see restrictio L n side)
tf\ VCA re e e o\r eiu .
Tawn\ gal description `Q l-, lw Record numb(;/ a�� Pa number s t3� Kew number/ _1 20�Q� . Slit U — V \ , 2 O k t
Assessed value of real property as of 2 6 Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the ap licant the sole
assessment date,current year assessment date,current year date applica on 0 CZ) legal quitable owner?
2Yes 0 No
If no,what is his I her exact share of interest? If owned with meon I ��r than spouse,indicate with whom
ff name on record is different than that of applicant,indicate below: s property in question:Annually Assessed
Real Property 0 Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of pu�ig��age ar contract seller n ,
(` I.) 1 1CA c .7.l t
Address of mortgagee or contract seller(number and y-`--•-.Mr and ZIP code)_ _ F I -� r�-
_L."
Name of assignee or other owner or holder of rnortga p` 0 / / 5- /
- DEC 2 6 2019
Address of assignee(number and street,city,state,s Drawer NO
Does applicant own property in any If yes,what a n been requested I err Q $ 1 deduction
i nIndiarona? ❑yes ❑No Card NO. Yes [ off .N t'0UNTY AUDITOR
A person is not entitled to this deduction unless ontract indebtedness that is recorded in the county
recorder's office(including any home equity fin that is the basis for the deduction.
COUNTY AUDI I UK
Deduction approved in the amount of:
•
20 20 20 20 20 ' 20' 20
Signature of Coun o •0;,.itor County r\ Date(month,day,year)
kt.NYO3 —1 �c),11 1Z 26
I/We certify under the penalty of perry that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owners full name at_
'n pI Date mo�tiyda year)1 ident address of applicant(number d sbee,city,sta e,and ZIP code) �C/• l '
- 6 20 C lAb wln ' ,ice .
Person authorized by duly executed Power of or oy 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.