HomeMy WebLinkAboutMortgage_James (3) - . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
- y FOR DEDUCTION FROM ASSESSED VALUATION 124bkg::� State Form 43709(R13/10-15) %\,3„1 20l9
% ,.,,;:,,, Prescribed by Department of Local Government Finance
INSTRUCTIONS: \n'il _ 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 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 bi
yekk see restrictions on revers
SAT
T g stri tittK number/legal description Record number Page number
—ok 2�=pop —ooc� .� 3 —ow col Ss2. i
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortg e/Contract indebtedness ru�id as of Is the applicant the sole
assessmentdate,current year assessment date,current year date Epp on lJ`' legal or
1`((Vv1l g q able owner?
Yes ❑ No
If no,what is his l her exact share of interest? If owned with omeone othlr than spouse,indicate with whom
If name on record is differentihan that of applicant,indicate below: s e property in question:Annually Assessed
Real Property 0 Annually Assessed
• Mobile Home(IC 6-1.1-7)
N of mo .a ee or contract sel .5 A L . iILED
'N` C, ..
Address of•• _•-e or contract sell 4►u ber and street city,state,and ZIP code)
DName of assignee or other owner or I E C 2 13
jME51 51EVE7-) G-'
Address of assignee(number and stn
_IE'A 0A L• OISSON COUNTY AUDITOR
oDoes ther countyicant own property in any this deduction been requested If yes,state amount of deduction
in Indiana ❑Yes ❑No l 1 9 — Sa 51 ant year? Li❑Yes ❑No
A person is not entitled to this ded: utgage or contract indebtedness that is recorded in the county
recorder's office(including any hot fer's office)that is the basis for the deduction.
'Deduction approved in the amount of:
20 20 20 20 • 20 ' 20' 20
Signature of ;'1 M Co ty� Dat1( nth y ye1�
I/We certify under the penalty o perjury that the above and foregoing informatr true and correct and that the applicant is a resident of Indiana and
owner/co tract buyer of the aforementioned property on date application is filed.
Si afore(own s full name) Date(month,day,year)
qjity
ul resident
t dd sssf applica number and steet,city,state,aid ZIP,co iel, f
51 Q1r11, )-.i 1rv`'��rY, v. •
Person authorized by duly executed Power of Attorney or byrfl3'6-1.1-12-0.7 / Date(month,day,year)
Address of authorized person (number and street city,state,and ZiP code)
The Penalties for nedury can include imprisonment up to two and a half vears and a fine not to exceed S10.000_