HomeMy WebLinkAboutMortgage_Hauschild n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County I Township Year
i _ FOR DEDUCTION FROM ASSESSED VALUATION �"! 1 E
'ot i State Form 43709(R12/6-14)
g�i
\ �l Prescribed by Department of Local Government Finance
INSTRUCTIONS: JUN 2 3 2015 File Mark
To be filed 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.
Must be filed or postmarked with the County Auditor or County Recorder of the county v re re the7� �� e - $D County 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 imam Jouwr7)e PrID lyTOR
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.
Appli nt wrier or con(ranI buyer-se sstnctioo�nnss oonn�reevv�erseesside) aciaisdiabi
Taxing /( ry Key number/legal description Record number Page numb r
�1.r ab-19—/Se— 00a oco e 44e oaf /5 .07Y
Assessed value of real properly as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant e the sole
e
Marts 1,wnent year March 1cu�t year O date of application legal or equitable owner?
C/O (10 ❑ 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
Weal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
' Name of mortgagee or contract seller //�'
Address of mortgagee or contract seller(number' and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
N4uscasLp, !bM 15
Does applicant own property in any If yes,what county? What Taxing District? _ 1 it of deduction
other county CA 12yyf,r+
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the per. id in the county
recorder's office(including any home equity line of credit that is recorded in the coun l5 -Ca
COUNTY AUD
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/contract buyer of the afore ntioned property on date application is filed.
Sig l resi a refs full nas / l / / / Date(month,day,year)
Il resid n ad f pplicant(number and street, r ,d ZIP code)
Person authorized by my executed Power of Attorney or by IC 61.1-12-0.7 % 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.