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HomeMy WebLinkAboutMortgage_Spindler (3)�'�' � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS �"-� : FOR DEDUCTION FROM ASSESSED VALUATION Townshi Year 9 '�, : y Stale Fofm 43709 (R4 / 10.01) J � �� PrescriDeC Dy Department of Local Govemment Finance INSTRUCTIONS: File'Mark r /] To be filed in person or by mail with the CountyAuditoro/the county whe2 the property is located � ��. �� �..,... ,.. Filing Dates: 1) Real Prope�ty: During the 12 months be%re May 11 of the year the deduction is t_ e� ����h � y r,UDI i OR1 2J Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ the year he deduction is to be elfective. See reverse side for additional instructions and quali�cations. Applicant (owneLOr contract buyer - see strictions on reverse side) L" � Tacing Distrid Key number / legal descripti Recor numbe � a -�/� � � _�O ^ 7 _ Page number .� Assessed value of real property as of MoRgage / Contrect indebtedness unpaid as of Is the applicant the sole legal or equitable March 1, current year March 1, current year owner? ❑ Yes ❑ No /ao, ao 0 If no, whal is his / her exact share of interest? If owned with someone olher than spouse, indicate with whom. If name on record is different than that of applicant, indicate below: Is the property in question: ❑ Real Property ❑ Mobile Home (IC 61.1-� �e of mortgage r contract seller ^ Address ot mortgagee or contrad seller (number and st�eet, city, state, ZIP Name of assignee or other owner or holder of mortgage Address of assignee (number and street, city, state, ZIP code) Does applicant own property in any other If yes, what county? What Taxing District? Has this deduclion been requested on county in Indiana? property for current year? � Yes � No COUNTY AUDITOR Deduction approved in lhe amount of: }- `S�` 3G - 3 -/�j � '�/S� zo p�. �� zo � zu zo zo � zo �$_ zo � � 5 � � �' ig � ture County Auditor Dale 'Ve certiy under the penalty of perjury lhat the above and foregoing information is true and corred and lhal lhe applicants was / were sident of Indiana and owner of the aforementioned property on March 1, 20 � Signature (owners full name) Person authorized by duty executed Power of Attorney „ .Q /Q, , or by IC 6-1.1-12-.07 �vci aw�-�� Fu resident add ss of applicant Address of authorized person �R �q' ,c�� /,7a /�l�a.��a�"a.c� s ap� - �w STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year =.tit FOR DEDUCTION FROM ASSESSED VALUATION �•,i_ State Farm 43709(Rl3/10-15) -• - S; %! Prescribed by Department of Local Government Finance INSTRUCTIONS: File Mark To be filed in person or by marl. Form tied with: Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction{41441/24 2017 Must be filed or postmarked with the County Auditor or County Recorder of the county whbie hf a property is ❑ County Auditor , located on or before January 5 of the immediately succeeding calendar year. 2) Mobile/Manufac6ued Homes not assessed as Real Property.Must Re with the County -• n • of ' -••'' ❑ County Recorder where the property is located during the twelve(12)months before March 31 of each year..J.,; >r.`� !•, •1, OR See reverse side for additional instructions and qualifications. GIRSOM COUNTY A • Applicant(owner or contract buyer-see resbfrrimis sbei �r�f a 9-'77 4 'Yidnq ben/legaldr C)'`,7C�.G� l r Im,mDer Taxing IT Q b-/7—c 36 Yoe 0009 S 3umbgr k+7 Assessed value of ma property as of Mortgage/Contras indebtedness unpaid as of • Mortgage/Contract indebtedness of Is the ap sole assessment data,arrant year assessnmd data,anent year date of application legal or equitable owner? /5'6 0 d d ❑ Yes ❑ No If no,what is his/her exact share of interest? if awned with someone other than spouse,Indicate with whom If name on record's Oferent than that of appfimrq indicate below. ([s the property perty in question:M�y nuaiyAsstssed Property Motile H 1.1-7) Name of rcortgagee ar contract seller 14 A 1 Address of iuu,tyeyee or contract semi(amber and street city,state,and VP axle) Name of assignee or other owner or holder of mortgage ' • Address of assignee(number and sheet sly,state,and VP code) • Does applicant own property in any If yes,what county? • What Taxing District? Has this deduction been requests If yes,state amount of deduction in iInd'inya? ❑Yes 0 N cement�? ❑Yes 0 No 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 y fine of credit that is recorded lo 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 Suyxahure of CpwryAUddar ---- - -. .. 1� - - l Date(month,day,year) - I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and comer/contract buyer of the aforementioned property on date application is filed. Signature name) „ Date(month,,day,year)\r 9 street - e,and ZIP /-5- 45 2j5 cw c / #a td` &-x_ -/ 2 J 9 Person authorized by duty exec d Power of Attorney or by 1.1-12-07 r Date(month,day,year) Address of authored person (number and sheet illy,state,and ZIP code) The penalties for perjury can include imprisonment up to two and a hat!years and a fine not to exceed 310,000.