HomeMy WebLinkAboutMortgage_Hasselbrinck i:l4. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.✓.,t .x FOR DEDUCTION FROM ASSESSED VALUATION " �,
:.; _ I L ,D
State Form 43709(R12/6-14) • H
\\*,,;:---.?" Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be fled in person or by mail. AU G 28 2015 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]] .petty i, d III County Auditor
located on or before January 5 of the immediately succeeding calendar year. Il' .lRr1/h ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County:4141 r( •.•:.r; AU JITOR
where the property is located during the twelve(12)months before March 31 of each year the deduction is soug t.
See reverse side for additional instructions and qualifications.
Appl' nt( er or contract buyer-see restrictions on reverse side
1 l i►1.oc a
T ng District Key number/legal description Record number Page number
-24 - 17- /6. 300 - 003, 7 (01 .-0 J-/ 8003 /600
Assessed vale real props of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,Current year date of application legal or equitable owner?
. C1 900 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone othef than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: . — —
I Is the property in question:Annually Assessed
1r
Name of mortgagee or contract seller , ` '73 �/ e 0_0,0 "3�
(/�- Drawer No.a
Address of mortgagee or contract seller(number and street,city,state,and ZIP code ''..
� �
I/ao0
Name of assignee or other owner or holder of mortgage Ca 1 (� 1`'Q,
Addre,s of assignee(number and street,city,state,and ZIP code) -
P)T w SW i(< 3 / A /0 .0 4- L
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county , property for
in Indiana? Yes ❑No current year? ❑Yes ❑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 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 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•owner I contract buyer of the aforementioned property on date application is filed.
I(' Sig a(owner's full name) / Date(month,day,year)
\ 40. , ..K _
ifu0 r dent address of applicant(number and street,city,state,and ZIP code)
J(
—1 My S 1 050 to Owertsw:ue JAI �7o/oc
Person authorized by duly executed Power of Attorney or by IC b1-1.1-12-0.7 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 S10,000.
l -n--s------- .
�"° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-� -_ : FOR DEDUCTION FROM ASSESSED VALUATION
�. � � Siate Fofm a3709 (R4 / 70-01) '
� ,u.
PrescribeC by DeDartment of Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is locarea.
Filing Dates: 1) Real Property: Dunng the 12 months be1o2 May 71 of the year the deduction is to be effect�R 1,�4g�
2) Mo6ile Homes assessed�under IC 6-1 J-7: Between January 15 and March 31 0! the y/ea�r the deduLkion e ef/ective.
See reverse side /or additional insWctions and quali�cations. // /(� n n
Appticant
Tauing Distrid
�� ��
Assessed value of res
March 1, curreni year
rtract buye - see r��nctions on rev rs side) •�
l�
Key number / legal description
� 7- U ��
property as of Mortgage / Contrad indebtedness unpaid as
March 1, current year
Record number
Page number
Is the applicant the sole legal or
owneR ❑ Yes ❑ No
If no, what is his / her exad 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 queslion:
� Real Property ❑ Mobile Hane pC Fr1
'ame of mortgagee or contrad seller
Address ot mortgagee or contract seller (number and street, city, state, IP
Name of assignee or other owner or holder of mortgage
street, city, state, ZIP code)
Does applicant own property in any
county in Indiana?
Deduction approved in the amount of:
20 � � 20
if yes, what county? � What Taxing Distrid?
COUNTY AUDITOR
20 �1L 20 � 20
�
County Auditor
Has this dedudion been requested on
property for current year? � Yes ❑ No
� �'�]
Date
�
/ We ify under the penalty of perjury thal lhe above and foregoing infortnation is true and corred and that ihe applicants was / were
resi nt of Indiana and owner of the aforementioned property on March 1, 20
g ture (own s/ull name) Person authorized by duly executed Power of Attomey
� �, � _ �� � or by IC 6-1.1-12-.07
1. A I n IAddress of authorized person