HomeMy WebLinkAboutMortgage_Hall (8) ,;, ,7.. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County township Year
j : - FOR DEDUCTION FROM ASSESSED VALUATION 1 0\6,
�1 ,Os• Ir State Form 43709(R13/10-15) ( 1\ C�
sy •%�' Prescribed by Department of Local Government Finance JJJ
INSTRUCTIONS: �
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is I County Auditor
located on or before January 5 of the immediately succeeding calendar year. ill 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county County Recorder
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 contra buyer- restrictions_ ns qn reverse side)
E13'1
Taxing D' ct u r/legal description Record number Page number
0\oA - K -1'S-13 - _o vl • 2C1 001 7020 00Ei
Assessed value of real property as of Mortgage/Co ur .i"nde edness unpaid as of Mortg e!Contract indebtedness unnppaaig�as of Is the a plicant the sole
assessment date,current year assess td..•, ent r date ap I CJ legal or 'table owner?
a': � )/cjO O u • Yes 0 No
If no,what is his!her ex h-Ia•f u re If owned with s meone other than spouse,indicate with whom
If name on d is d II,- 'I. a''Zi app cant,indicate below: Is property inquestion:Annually Assessed
Real Property 0 AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee r contract seller
.. \19-C.A.tAddress of mortgagee or contract seller(numbe and streetcity, to and Z!Pco
f
Name of assig! d.` 0 _ 0 0 8 8 -—— 'Fit 1.1-
Drawer NO JAN ® � 202Q
Address of as:
I - "
Does applican Card NO. strict? as this 1. 1.n been're uested If yes,state amount of deduction
county :d't)
other � ,,nn�
in Indiana? "I'c (-•-ni' f No
A person is ii n tii i i hiio gage or contract indebtedness that is recorded in the county
recorder's office(rncruamg any norrre eyuuy ma Ell Lel MA&u,a.I .Gw.a.v..,,.the county recorder's office)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 uditq f County Date( opt day,year)
�nn1 Gso •20 20 •
I/We certify under the penalty of perjury 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) Date(month,day,year)
F it resident ddress of ap n number and city,slat ,an ZIP code)
Person autho' by duly efecuted Powbr of Attorney or by IC 6-1.1-12-0. 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.-