HomeMy WebLinkAboutMortgage_Speicher STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.d ,,. FOR DEDUCTION FROM ASSESSED VALUATION �I}
t�- Slate Form 43709(R12/6-14) �1 �►
--- Prescribed by Department of Local Government Finance I
INSTRUCTIONS: File Mark
To be filed in person or by mail. MAY Il fi?5h:
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 ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year.
Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the count
where the property is located during the twelve(12)months before March 31 of each year the deductio GAMS CUU I Y AU DI I UK
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
;I1 a i >JC a �Y� l�(
Taxing bict Key nu er/legal desaiptio Record number Page number
6-17- n-} .2k - ,Lo- 33 - ciao-oof. 95' 5- 00 / 20 IS 13ep
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 of application legal or equitable owner?
90 QQ 0 ❑ 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 se r -,
Address of mortgagee or contract seller(numb e,city,state,and ZIP code) Nor ��
yM/Q1— ��^EAtiG CC
Name of assignee or other owner or holder of mortgage D1�Z e r t S Pe 1�Q`pp/`
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�x S� tc= o
Address of assignee(number and street,city,state,and ZIP code) 1
pr S NE SE 33- 3-9 l . a1ft C:)td ,�O. ... �
Does applicant own property in any If yes,what county? What Taxing District? a0(5_ .. •.. ction
other county on property iu J
in Indiana? ❑Yes ❑No current year? ❑Yes LI nu 1
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 Auditor �y County Date(month,day,year)
/Liu/ c 2 x' vv'_
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(owners full name) / Date(month,day,year)
Full resident address of applican* umber and stree city,sta e,and ZIP code)
' o o / ! 76,(3
Person authorized by duty 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.