HomeMy WebLinkAboutMortgage_Frantz a „..•>.% STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
— , FOR DEDUCTION FROM ASSESSED VALUATION
r'�% State Form 43709(R12I6-14) FILED
\ '•, Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. MAY 8 Friod 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 property i K. County Auditor
located on or before January 5 of the immediately succeeding calendar year. # 4 IRS ounty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the co.• fJ"t
where the property is located during the twelve(12)months before March 31 of each year the dedalaSON t(QljpUN • • I a I TO R
See reverse side for additional instructions and qualifications.
Applicant(own tract buye restnc son vacs s• e)
Keeynumber I legal description Recor numb Pa ^i e�
�� `z — ot(v 0 (S ao ct-0oo. 030 (� 7�
Assessed value of real as of Mortgage/Con' t indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,curt r date of application legal or equitable owner?
ODD ❑ 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 the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller d � �} ' n
Address of mortgagee or contract seller(number an treet,city,state,aand ZIP code) l^(,/�f`'
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any I If yes,what count-n-- What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? CI Yes CI No_ / current year? ❑Yes ❑No
A person is not enfin<r las a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorders car 22'O" / ' !is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
p ! ,:••" •••
20 20 20 20
d'iN0• •
Sigi CCU" • County Date(month,day,year)
I/- _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 uU name) /r Date(month,day,year)
///� [/.� �'/dam/O��
Full res3ent ddress of apptcan number and street,city,st j-nd ZIP code)
X015- 5 fiv siorJ ST �AKL.A)Jo Ci-n' CO -1-7460
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 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 510,000.