HomeMy WebLinkAboutMortgage_Dixon (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
!,, �h.. FOR DEDUCTION FROM ASSESSED VALUATION■ State Form 43709(R13/10-15) FIL
,
' Prescribed by Department of Local
t prope is County Auditor
located on or before January 5 of the immediately succeeding calendar year. . 0 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Cou �� T
where the property is located during the twelve(12)months before March 31 of each y� 11 N udWpp OR
See reverse side for additional instructions and qualifications.
Applicant ner or contract buyer-see res bps on reverse side)
Applicant
Taxi g District Key number/legal description Record number Page number
?it o' - /9 -/? —a0 '— Doi. 3 / 7 - 0a-6 ao/ , Vv89 ,
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessmentdate,current year asspS.sment date,current year date of application legal or equitable owner?
/oaf' QQD ID Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone othd than spouse,indicate with whom
if name on record is differentthan that of applicant,indicate below. Is the roperty in question:Annually Assessed
[ eal Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 5/3 —
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) / U / /
Name of assignee or other owner or holder of mortgage >`»`
Dra aver No
Address of assignee(number and street,city,state,and ZIP code) .... ..........
Does applicant own property in any If yes,what county? What Taxing District? Card No luction
other county . •••....
in Indiana? ElYes ElNo .............
A person is not entitled to this deduction unless the person has a balance on the person.._...__ _ _ _ he county
recorder's office(including any home equity fine of credit that is recorded in the county recorder's office)that is uau.,..w___
COUNTY AUDITOR /
Deduction approved in the amount of:
•
20 20 20 20 20 ' 20' 20
Signet a of County Auditor ,_ / County • Date(month,day,year)
I/We certify under the penalty of perjury that the above d foregoing information is true and correct and that the applicant is a resident of Indiana and
own r/contract buyer of the aforementioned roperty on date application is filed.
>O Sign (owner' name l Date(month,day,year)
f V
/FdI resident ad ess of appli umber an street,c state,and ZIP code)
JS <32' ( 7�.Sr S - . ?, '', J/ran- �7� fie
Person authorized by duly executed Power 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 un to two and a half years and a fine not to exceed$10.000.