HomeMy WebLinkAboutMortgage_Rosder , . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
=l,: FOR DEDUCTION FROM ASSESSED VALUATION74X 1 ,1- {(1
State Form 43709(R13 110-15) 3i1 r> I 1\ . al
Prescribed by Department of Local Government Finance 1 -Y
INSTRUCTIONS: • File Mark
To be filed in person or by mait F 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. ounty 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.
App. nt(maker or co buyer t see restrictions on reverse side) — •
Taxi District Kumber!legal description —ooI 232-- oL/ Record number Pag�nu�ber
1' -,,q-i q -�o4 b Z 9 C_ $6
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortga el Contract indebtedness un id as of Is the a pliant the sole •
assessment date,current year assessment date,current year date ppiica}(on� t0 n a legator q ' ble owner?
11``CCfF^^JJ C/� Yes ❑ No
If no,what is his/her exact share of interest? If owned with s etne other than spouse,indicate with whom
If name on record is different than that of applicant, ----- - s e property in question:Annually Assessed
Real Property El Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mort• ee or co tract seller
db" Ws*ef) AO€Cer rYark , ,
Address of m rtg-•-e or contract seller(numbers
,.
.,D
. „ -4
Name of assignee or other owner or holder of t11011 Wk(ck.e7) Z--061.-LT _1
Address of assignee(number and street,city,stat, 2020
Does applicant own property in any If yeses wha ( �� — been r-qu- =• If yes,state amount of deduction
other county C� e.?
/►(yam' '
in Indiana? ❑Yes El No "� � ❑No
'1,�;--
A person is not entitled to this deduction unl / cpiht3b�crdrss that is recorded in the county
recorder's office(including any home equity' ' �/ 9 hat is the basis for the deduction.
- —d
Deduction approved in the amount of: -
20 /p 20 cu I I ' 20' 20
I
Signature of Coun ditor ` County Date(month,day,year)
Ali
I/We certify Lin.er the penalty of perj : +- -.ove and foregoing information is t u and correct and that the applicant is a esident of)
f ndiana and•
owner I contract buyer of the aforementioned property on date application is filed.
kSe(ownesuIlnarne)
Os,,\,
Date(mortih 2 O
F .sent dress of applicant(nnuumber and street r ,mate, nd ZIP co e)
Person -
rs a authorized by duly executed Power eAttorney or by IC_6-1.1-12-0.7 J 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. •