HomeMy WebLinkAboutMortgage_Hofman :o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Year
__, ? FOR DEDUCTION FROM ASSESSED VALUATIOTILTED.
2 State Form 43709(R12/6-14)
\,--, Prescribed by Department of Local Government Finance
INSTRUCTIONS: JUN iit°MIS
To be filed in person or by mail. JUN •6 Form filed 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 prope i , i A M ounty Auditor
located on or before January 5 of the immediately succeeding calendar year. ,, w9 •
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditors'S$EM1 OU NT !♦!am hecorder
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.
Applicant(oyrrer or tract buyer-see restrictions on reverse sisal %
T ing 'strict Key)number/leg escription Record number Page number
a-6 - (l - Apt-0D ( - —1(40 l — Oct"( a o 15 a `L 7
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
1,current year March`1,current year date of application legal or equitable owner?
TSpp DOD .�.res ❑ No
If no,what is his/her exact share of interest? '� If owned with someone other than spouse,indicate with whom t
If name on record is different than that of applicant.indicate below: 'peal the property in question:Annually Assessed
1[J}Ceal Property ❑ Annually Assessed
�'�" Mobile Home(IC 6-1.1-7)
Nam of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) - - --k Name of assignee or other owner or holder of mortgage �� / \� \S
Address of assignee(number and street,city,state,and ZIP code) '10\\'' /, r _`,,,�
Y‘—'1'S..–C l�'...pV �r —x ,00
Does applicant own property in any If yes,what county? What Taxing District? Has tt y--• 5OO b -..action
other county on pro, 'g
in Indiana? ❑Yes o current
A person is not entitled to l is deduction unless the person has a balance on the person's mortga Cvr. _.ass that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's ' ...e oasis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
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 I contract buyer of the aforementioned property on date application is filed.
Signature(gyner's rue 7,, • ,, . / Date(month,day,year)
Full sident dress of applicant(nu .er and sire q'ty,st e, - d ZI•code)
'ell 47-x' ` ' F. fiat- rs. 6 6 ! '17639
Person authorized by duly executed Power of ttorney 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.