HomeMy WebLinkAboutMortgage_Davis (12) , . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C unty Township Year
; 1. FOR DEDUCTION FROM ASSESSED VALUATION n„
I _ State Form43709(R13/10-15) P ►' I
'''%-, Prescribed by Department of Local Government Finance S )I �� ` J �01
INSTRUCTIONS: Mcte.d File Mark
To be filed in person or by mail. e' ' filed with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which a 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.
nt(owner or con Wer-see restri o on reverse side)
O DV Clues 1 s
T D . Key n m r/legal description' Record number page number
26-0-23-20o-o01 . fl-E- 02-% , 20 10 52-8G
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaas of Is the a r nt the sole
assessment date,current year assessment date,current year date of a i ^ w ^ _ ` legator 'table owner?
V))(`J1 /l./1 Yes ❑ No
If no,what is his/her exact share of interest? If owned with somep a other tharrspouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is t e property in question:An ualty Assessed
. eal Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mo ee or contract seller
rI # ..,E ..
Address of mange e or contract seller(number and street,city,state,and ZIP code) F
Name of assignee or other owner or holder csr--'---- DEC 3 0.2019
Address of assignee(number and street,city a t s 3I 34� 2I
Does applicant own property in any If yes, IathArk, in cluctial u d1 WYe•A t of deduction
other county r for
in Indiana? ❑Yes El No ir? ❑Yes 0 No
A person is not entitled to this deduction 19- '5A g 6 s or contract indebtedness that is recorded in the county
recorder's office(including any home eq fce)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of.
•
20 20 20 20 20 ' 20' 20
Signature of Coun u or 1'i I County • Date( .-i,;,dda y�r9
�i
1 IIJ. •
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applican a re dent of Indiana and
, owner/contract buyer of the aforementioned property on date application is filed.
=ture(owne full name) Date(mop day,ye
� 1 )L14 IV . �Z 30
1.ent dr.ss of applicant nt per a d street f and ZIP code
:OlS- W p ` /� �t -3y) ^ L19-66
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 vears and a fine not to exceed 510.000_