HomeMy WebLinkAboutMortgage_Ravellette (3) 06`r14'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
%+�9 FOR DEDUCTION FROM ASSESSED VALUATION -�
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\\ State Form 43709(R13/10-15) GIBBON P \ OW' t �V D
f'•e_,� Prescribed by Department�of Local Government Finance
INSTRUCTIONS: Y0L1„^ `-7 2z.1 9 File Mark
To be filed in person or by mail. r� ( l V v 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 XCounty Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ 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 sought.
See reverse side for additional instructions and qualifications.
Appli nt(owner or co tractbu er-se restrictions rever e de
"on /V1i .
Y .QA
Taxi " t Key nu er/le��I d esc tik Record number Page number
-2, - { •-ki0o--000 SgL-1 .020 20 20 2c1lY
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the pplicant the sole
assessment date,current year assessment date,current year da a ai of plicat' n j0C" legal o e Liftable owner?
tb 0 Yes ❑ No
If no,what is his/her exact share of interest? If owned wi someone other than spouse,indicate with whom
If name on record is different tha I th property in question:Annually Assessed
RAII&LLEIL) / oti p Real Property ❑ AnnuallyAssessed
J"(11'1 /� Mobile Home(IC 6-1.1-7)
Name of mort or contract (4Li /►
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Address of mortgagee or contra T 10 -
' ,
Name of assignee or other own v �� -'
JUL 1-3 2020
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Ha r�t ,•,•-,2-4-4 !6i),requested If yes,state amount of deduction
oinher Indiana? El No GIB��}rny -rQ�I-Q`r�§1DfThIu
❑Yes
A person is not entitled to this deduction unless the person has a balance on the 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 2L 20 20 20 20 20
Signature of Co dito [\ County \,i O n Date.1,7 th,dal r �es3
I/We certify under the penalty of perjury that the above and foregoing information i e and correct and that the applicant i a relident of Indiana and
owner/contract buyer of the oremen' ned property on date application is filed.
)( Sign re(owr/r�/ , a
s full am ) Dateqth,day year)
•
ul resid (address f ppli nt(nu ber and street,ci te,and ZIP code) ��C lI
&,1
Person authorized by duly executed Power 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 nenalties for neriury can include imprisonment un to two and a half years and a fine not to exceed S10.000.