HomeMy WebLinkAboutMortgage_Wolfe (4) <on-n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
at. FOR DEDUCTION FROM ASSESSED VALUATION ��-
trii State Form 43709(R12/6-14)
�— Prescribed by Department of Local Government Finance r_ ��
INSTRUCTIONS: i IIO r .'
To be fled in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. A 1 00----r01 oD4f cC
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property IAiAY 1812 O.iprnty Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) 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 deduction is sot/dll
See reverse side for additional instructions and qualifications.
• _ •
Applicant(o ner pr contract buyer-see resift _ _
T ng"'strict K number/!eclat description Record umber Page number
6- DL-ao -loo-oo . ��i6-o1 � X614 �l8,
Assessed value of real properly as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contrac indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
10/i ' ❑ 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
1r Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller f (144-aktdon. b) ,
Address of mortgagee or contract seller(number and street,c i ty,state,and Z de)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP'code) (111.1:1•E ,—�-{
Does applicant own property in any If yes,wha Q�' .a/ n been requested If yes,state amount of deduction
other county �/
in Indiana? Dyes ID No 'Drawer NO VII DYes ❑No
A person is not entitled to this deduction unit ontract indebtedness that is recorded in the county
recorder's office(including any home equity 8 I that is the basis for the deduction.
Car NO.
Deduction approved in the amount of: o)etc, 38 o0
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20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I 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.
si (owner's full amee)�),,��.. ,tN(�' Date(month,day,year)
Full resident address of applicant(number and street, state,a ZIP cod ,
438'4 N locoAalo- 41 b�fq
n 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 tine not to exceed$10,000.