HomeMy WebLinkAboutMortgage_Luecke STATEMENT OF MORTGAGE OR CONTRACT INDE S �, ,'t Township Year
gilt FOR DEDUCTION FROM ASSESSED VALUATION I )• '
State Form 43709(R12/6-14) Ills
\ -J Prescribed by Department of Local Government Finance JUN
INSTRUCTIONS: 1`� File Mark
To be riled in person or by mail. , 41 Form filed with:
Filing Dates: 1) Real Properly:Must be completed and dated in the calendar year for which the de.1'I!' (r�1R ®
Must be filed or postmarked with the County Auditor or County Recorder of the cou_ . 1 e(p(Ar3" / County Auditor
located on or before January 5 of the immediately succeeding calendar yeas(fSO ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicp1((owner or buyer-see restrictions on reverse s
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T IDistrict Key number I legal description Record number Page number
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Assess value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the app scant the sole
March 1,anent year March 1,current year date of application - legal or equitable owner?
0025 Q ❑ 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 ort ag or contract seller —
Address of mortgagee or con ct er(number and street,city,state,and ZIP o
Name of assignee or other owner or holder of mortgage //��
Address of assignee(number and street city,state,and ZIP code) 1 ___ (J.,„^ '
Does applicant own property in any If yes,what county? What Taxir 3 s��1 ` I�`'l A�'1".'_r%11 e amount of deduction
other county
in Indiana? ❑yes ❑No
A person is not entitled to this deduction unless the person has a balan recorded in the county
recorder's office(including any home equity line of credit that is recordr uction.
4 _
Deduction approved in the amount of: 4-
20 20 20 °Wig 080045oa. 114 20
Signature of County Auditor day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true ana correct dn■ mat,,... _.. . resident of Indiana and
owner ontract buyer of the aforementioned property on date application is filed.
Signal (owne?s f a ems) Date(month,day,year)er si—nt addres • --nt(nu• ber and street, sty,state,and ZIP code)
X 18 1�1.. LAY L .1,c,Y\sv`1l� �N. y�c7 ,5
Person authorized by duly execut 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$10,000.