HomeMy WebLinkAboutMortgage_Mayberry �f 9, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
di, s� FOR DEDUCTION FROM ASSESSED VALUATION
� _ State Form 43709(R13/10-15) On
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,,. Prescribed by Department of Local Government Finance
INSTRUCTIONS: ' File Mark
To be •filed in person or by mail. i'tCI S t- — Form 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
2) located on or before January 5 of the immediately succeeding calendar year. County Recorder
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.
Applicant(owner or contract buyer-see restrictions on reverse side)
11
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Taxing District Key number I legal desdr_iption 1 RecoLd number Pagpr�u bl•
co -‘ 9- Ig - lot - oon . aa (40 -oa(� oa0 Q(J I)Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant�e sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
17Or 0 & a• oo '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
[real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Na e of mortgagee or contract seller
map p M o(-4- Re, L,-rv, `I7(3/4 t90 Lot nourICi a I S2rv(` GPS-
Address of mortgagee or contract se (numb r and street,city,state,and ZIP code)
F/LE ;I",
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) JUN 1.5 2070
Does applicant own property in any If yes,what county? What Taxing District? as this d-ducti.7 .een requested If yes,state amount of deduction
other county pro.-••I. --•01
in Indiana? ❑Yes [`'No l ,,,.i.! �r"!i1'►0 Yesr�❑No
tl
A person is not entitled to this deduction unless the person has a balance on , Wj It g'6r e I iRR btedriess 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 MI') 3 20 20 20 20
Signature of Coun or County Date onth,day,year)
O
I/We certify un er 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.
Sign r (owner's II nam Date( da9y,year
Full resi/d add ss of applica ( u ber and street,city,state,and ZIP code) d// ��
CI Pi, pal ( a. `Rn�-- g(th,(\L' k . T i\t tnLP V6
Person authorized by duly executed Power of AttomeYor by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
Tho nana►tiac for oeriury can include imprisonment up to two and a half years and a fine not to exceed$10,000.