HomeMy WebLinkAboutMortgage_Hinshaw 14 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
•� FOR DEDUCTION FROM ASSESSED VALUATION
r,! �'''' State Form 43709 R12/6-14 RECEVED 1
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b ie Prescribed by De artment of Local Government Finance
INSTRUCTIONS: �O li 't f'�t c '' r ''l1nl� File Mark
To be filed in person or by mail. a �l l\ t Form filed with:
Filing Dates: 1) Real Property:Must be pleted 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 lc County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Records
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.
Applicant(owner or contract buyer- ee rests Lions on reverse side)
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Taxing District I Key number/legal description Record number Page number
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the s•Ole
March 1,current year March 1,current year date ofappliica),on legal or eequilble owner?
`R (e(1// r 10CY) 2 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 property In question:Annually Assessed
Real Property 0 AnnuallyAssessed
Mobile Home(IC 6-1.1-7
Name of mortgagee or contract seller -
F -Vrw A pt / (-' 9- &af1ol�a,' _ I
Address of mortgagee r contract seller nu er and street,city,state,and ZIP c e '
• Name of assignee or other owner or holder of mortgage �\1OV 1 O 2020
-
Address of assignee(number and street,city,state,and ZIP code)
42)14-441
Y AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this ded�uttiii ii` tffq e'Ci sfed If yes,state amount of deduction
other county 1-,/ on property for T
in Indiana? ❑Yes tJ No current year? I. es ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or .n :ct 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
Signature of County r �" /""`'J County 1 Date(month,da yeah
fYlj 1r 1( �so� ` -1. ,''
I/We certify under the penalty of perjury that the above and foregoing information is tru d correct and that the applicant is a resident of Indiana and
- -owner/contract buyer of the-aforementioned- roperty-on-date application_is filed. _ __
Signature(own full Tierney ' - ' Date(month,d y,year)
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Full a ent ddress fast( tuber and scree ity,state,and ZIP co e) k /
fl •Lo ril r Si- V8 ,) UCtie-4 a IA d_ L:1,4--li
Person authorized by duly executed Power of Atfomey or by IC 8-1.1-12-0.7 t Date(month,day,year)
•
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 INDEBTEDNESS
Name of applicanL Name of rlortba eir contr l.�r '. 1 \(a.k.
Date filed(month,day,year) Amount of indeb dues Taxing District f_�
r fl pIn i�
Key number/legal descq'11',n 1�• qi�G IA\I 18 a 9 O �,
26 IS ��1 --Lk oz_ 0 00 .7 7S -00.1 712_,,, - si c19c. C
Signature of County Auditor/County Recor County Date(month,days,}'ea�j
wll�h Gln � ( NTY AUDITOR II- VS '` W��
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