HomeMy WebLinkAboutMortgage_Halbig n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
=e& a FOR DEDUCTION FROM ASSESSED VALUATION
s• State Form 43709(R12/6-14)
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Prescribed by Department of Local Government Finance i r �O I
INSTRUCTIONS: g ilrk
To be filed in person or by mail med with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. APR S Lf J
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. i ld-.unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the c.t'• Tr j�,
where the property is located during the twelve(12)months before March 31 of each year the deductig%it n' UNTY AUDITOR
See reverse side for additional instructions and qualifications. GICJU
Applicant(owner or con• buyer-see restrictions on reverse side
I^.9_ I bin 1 (Ce w a n� l v\A + l�Cete Ii yi vl At
Taxing District 1 `)K number/legald scription R drpum Rag�n lb
c2....-Ig- &5 -loo -Oda; oaf -025 chi 'bcz
Assessed value of real property as of I 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 equipbtb owner?
, —I . 6—cO• 00 Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone tither than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is trieftrepeny in question:Annually Assessed
Real Property ❑ AnnuallyAcc'ssed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller n
At-sue 1 nA, er(n r,fe--eq cte l �VY�
Address of mortgagee or contract seller(number an°dll55lreet. ity,state,and ZIP e)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own roperty in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county 1'// �n /I-- II on property for
in Indiana? Yes 0 N �QJld<fibLuz?A. current year? ❑Yes 0 N
A person is not entitled to this dedu lion 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 h quity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
5535LAirUen+nl ?D/ GI/4ASv, Ke COUNTY AUDITOR
Deduction approved in the amount of: 47:7-2 S
20 20 20 20 20 20 20
Signature of County Auditor 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/contract buyer of the aforementioned property on date application is filed.
Signature(owner's lull name) Date(month,day,year)
ull r aril address of applicant( ben and stir. city,state,and ZI code) i
Person authorized by duly executed Power of Attorney or by Ic S-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 hall years and a fine not to exceed$10,000.