HomeMy WebLinkAboutMortgage_Allen (13) .c�E"•Te9e STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
'- to FOR DEDUCTION FROM ASSESSED VALUATION
' w„ State Form 43709(R13/10-15) GIBBON �� ro
�— < Prescribed by Department of Local Government Finance 1.
,. 17 -" MrFile Mark
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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 dedu ".n . sought.
Must be filed or postmarked with the CountyAuditor or County Recorder of the county where the prep �� ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. p. N ,--'0 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:. , CZ
See reverse side for additional instructions and qualifications. /� PU 90' O
Appli nt(owner or contract buyer-see restrictions on reverse side) GOUN
(ir art..) v . A1ler) GOSo�
Taxing Distplt V Key number/legal description Record number Page number
249 //-/2- 20%_ c223, 61Y9-02g `2o26) / 7
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole.
assessment date,current year assessment date,current year date of application legal or equitable owner?
(-4550°, ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
VjReal Property ❑ Annually Assessed
�j� Mobile�lome(IC 6_1 1-7)
Na mortgagee or cjptract seller (�i `x-��1 ' V
atO &C
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) `"'1
Name of assignee or other owner or holder of mortgage E\J 1 c I,V 1 I I c •Icr cj`e 15
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own roperty in any If yes,what county? VVhat Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? Yes ❑No kQ� /�� current year? ❑Yes ❑No
A person is not ntitled to this deduction unless the person has a balance on a person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in 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
Signa e o County Auditor County Date(month,day,year)
. ) hsox- 5a�-(9D
�I/ e certify under the penalty of perjury th t e above and foregoing information is true and correct and that the applicant is a resident of Indiana and
der/contract buyer of the aforemention roperty on date application is filed.
ignature(owner's full name) Date(month,day,year)
) ....j
Full sident address of app" ant(number and street,city state,and ode)
Ar ,01/trn-- j VILIAL, ---lar q IR"-7C _
Person authorized by duly executed Power of Attorney or by Iv,6-1.1-12-0.7 Date(month day,yea
5.02L-ao
ate
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. -
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBT 1�tj Jc:'
Name ofiapplicant Name of mortgagee or contract selle
e ) V'T�F�,(,1 o �o1p
Date filed(mq�h,day ar) Amount of indebtedness T ng istrict � i�-�� J
66t COD e f ne L� • y �f
Key number/legal description 1(�OR
2, ,-//-)2•a -oro3., 049 -028/ k°o
Signatur aunty Auditor/County R corder County Date 0 ,year)
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