HomeMy WebLinkAboutMortgage_Eichmiller er'�', STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County triPEI�.J Year
e � FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14)
r= Prescribed by Department of Local Government Finance
INSTRUCTIONS: M Flli ! 1
To be filed in person or by mail. Form ued 'P:
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 ,i .un
i ),• . .
located on or before January 5 of the immediately succeeding calendar year. :!�r'ir!f:Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the @l9@ON 1 OU A _ a • -
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See�(e(y ir��(eAs for additional instructions and qualifications.
NppllchithW , con/rap-buyer-see reznctions on re rse e)
F L. €its iuwn•- a Viirryg.j - L tic ftmtur2
Taxin District Key number/legal description R co. P e mbe
. J9Aj lisp )10 -23- l i.-` 6-DO I. 64d-04 or aqGe(
Assessed value of real property as 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 pplication �.r `7� 00 legal or eeqq `ode owner?
$ date I I ( l.—� (� Yes ❑ No
It no,what is his/her exact share of interest? If owned with ssoll someone other than spouse,indicate with whom /\
If name on record is dterent than that of applicant,indicate below: Is th ropery in question:Annually Assessed
�y}2eal Property ❑ Annually Assessed
`�� Mobile Home(IC 6-1.1-7)
Name f mortgagee or contract seller �,n
i k�.1� ITS 1' ,b g cote.
Address of moggagee or contract seller(number and street,city,state,an P e) I
I D( rLA2� Cr BuU9 4 ub3 )EJI L 4 4 -7-7 (
Name of assignee or other owner or holder of mortgage F
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own prope i any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes No current year? ❑Yes El No
A person is not entitled t ' 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 Auditor County Date(month.day,year)
I f 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
owne n .ct buyer of th- o en..ned property on date appli.<tion is filed.
Si. aturt(o n: 'foci n me) - _ J . 1 Date( da •,ead.i
L • A. Ls_. • . .i�.a....: r ._ d
Full r sisild 1..a-d.ass•f? @ �d r city state,and ZIP code)�a,� ,
PPer'son, adthlo}/riz reddbbly ddiullyleexeeccutlred Power ofZAttome��s)6 -0.7 , �/ / Date(month.day,year)
PJII7&31 _
Address of authorized person (number and street,city,state,and ZIP code)
The penafties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.