HomeMy WebLinkAboutMortgage_Sharp (2) „-. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
., ;$ FOR DEDUCTION FROM ASSESSED VALUATION
• ?' ';. y, State Form 43709(R13110-15)
%4 Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. F d with:
Filing Dates: 1) Real Properly.-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.
licant(o err or ct buyer- rastr' 'ns on reverse side)
Taxing Dt ct V n ber I gal cription R Record number Page num r
Q ^ . --� — — �� 0(32 • \-0� • Z 2 oo 2-C .
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage Contract indebtedness unpaili as of Is the applicant the sole
assessment date,current year assessment date,current year date of licatio -— V legal ore itable owner?
�)(t�� v Yes ❑ No
If no,what is his/her exact share of interest? If owned with so eone other thadspouse,indicate with whom
If name on record is different than that of applicant,indicate below: property in question:Annually Assessed
RReal Property 0 AnnuallyAssessed
e Mobile Home(IC 6-1.1-7)_
Name of mortgagee arcpntr�c� II�� p .()
AA JA._
Address of mortgageebr con I e r( mbe`•nn�,t:ee "i ,statee`and ZiP code) '� -
Name of assignee or other owner or holder of mortgage GQ/W11/4]
hdrP
rrr�RRg (nl?gnn5
strew ' llterane'L Address of assignee(number and d�s IP code)
Does applicant own property in any es What Taxing District? at,
❑ Alan
other county Rio��,,,, (_c,Q_c(1,/j�� �_in Indiana? Yes GtH CO AUDITOR `•+
A person is not entitled to this deduction unless the person has a balance on the persc county
recorder's office(including any home equity line of credit that is recorded in the county
COUNTY AUDi”
Deduction approved in the amount of: — (�(C,
" '‘ s-L••-c
20 20 2 0 I GU 1�`JJtt ' 20' 20
I
Signature of County Auditor County 0. \ Date years
•
I/We certify under the penaltyof perjury that the above and foregoing information is tru�and correct and that the applicant is 1 resid Iof Indiana an`d!rtify P 9 rY 9 9 P ,
owner/contract buyer of the aforementioned property on date application is filed.
Signs (owners full ameAd4W(r) •
Date mo ayy 1
•
Fuld e�sident ad�of li (number`s11 $street city,state,and ZlP code)
10
Person authorized by duly executed dower 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 forperiury can include imprisonment un to two and a halfvears anda fine not to exceed S10.000.