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HomeMy WebLinkAboutMortgage_Farmer (6) �'�re STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year 7; __,--_1 . FOR DEDUCTION FROM ASSESSED VALUATION c: ,s >.r J1 State Form 43709(R13/10-15) r-4F�+E95�E® G SQn ©O� 2� '��;162%�° Prescribed by Department of Local Government Finance I�' Vd @ V` INSTRUCTIONS: AUG 1 7 2019 File Mark To be filed in person or by mail. T )t .k0'' 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 Auditor located on or before January 5 of the immediately succeeding calendar year. XCounty ❑ Count 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. Y /A y/ld Applicant(owner or contract buy r-see r strictions on reve se side) / 1 1 (?/-/910' Ni--- Lablii-(4 --j--' fiy)p „..?0,30000,26 3? Taxing District Key nu ber/legal description Rec d nu er Page n m r 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? /Sr g)V) 1 "ErYes ❑ 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 pr perty in question:Annually Assessed- eal Property ❑ Annually Assessed Mobile Home(IC 6-1.1-7) Name of morpiee or contract sel er irons v i/c /a c4c s i-ec/-&- 7 Ci/ ai Address of mortgagee or contract seller(number and street,city,state,and ZIP code) `< f:i . Name of assignee or other owner or holder of mortgage ti q- : 40 Address of assignee(number and street,city,state,and ZIP code) Q,p�' c0- Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been re � y ,state amount of deduction oin Ind county on n ety for E_()� in Indiana? ❑Yes �o current year? es fS A person is not entitled to this deduction unless the person has a balance on.the person's mortgage or contract indebtednesTfjr s reco d in the county recorder's office(including any home equity fine of credit that is recorded in the county recorder's office)that is the basis for the ption. COUNTY AUDITOR o4, Deduction approved in the amount of: 20 20 20 20 20 20 20 Signature of County Audito Et County , `` Date(month,da yt W -\ 0 ,0\ I/We certify under the penalty of perjury that the .s e e and foregoing information is trt7E-a'nd correct and that the applicant is a resi nt of I diana and owner/contract buyer of the aforementioned property on date application is filed. Sig ure(owner's full name) Date(month,day,year) .__Of.-1,4„,(4...4_ 72 R r ull resident address of applicant(number and street,l '"Vate,and Zia code) 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 neneltiec fnr neriunr ran inrlurie imnricnnmenf tin fn limn anti a half ueare and a fine not tn erreerd R'In nnn