HomeMy WebLinkAboutMortgage_Pohl ," . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
\1/44 el FOR DEDUCTION FROM ASSESSED VALUATION
,?'.•' L> State Fonn 43709(R12/6i14) •
,,,r, Prescribed by Department of Local Government Finance
INSTRUCTIONS:
FILE
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. JUL ,n ic
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is 1� t`U ty Auditor
located on or before January 5 of the immediately succeeding calendar year. Co ty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coon
where the property is located during the twelve(12)months before March 31 of each year the deducti,is
See reverse side for additional instructions and qualifications. tl COUNTY AUDI •
Applican f er or •ntractb -r-see restrictions on``re is %side `/ /
4 -L t d /, ' Q) /�/C-L
Taxi.. • al description Record number Pate number
fi��• !3/ �o-Oo/. X33 Ga Oohr` 7$23
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebt::ITS xar.PO Is the applicant the sole
V
011. 1,current year March 1,current year date of applcatio • legal or equitable owner?
enlai err. ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other tha spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is property in question:Annually Asp sed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
contact of mortgagee or contact seller
Address of mortgagee or contract seller(number an et,city,state,and 1 code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county I on property for
in Indiana? ❑Yes ❑No - --— — -- - _ _ current year? ❑Yes ❑No
A person is not entitled to this deduce ,I A irigage or contract indebtedness that is recorded in the county
recorder's office(including any home Po�L) /��131!F'�,/,.'"�fr{'1 Per's office)that is the basis for the deduction.
Deduction approved in the amount of: /5.d5;73 20 20 20 20 20
Signature of County Auditor 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 buay�er of the aforementioned property on date application is filed.
Signalu wneuun Date(month,day,year)
,47, //��/N/p//
Full resident dress of applicant(number and st city state/and ZIP c )
e(90W 975- h s I / Zv tt 71039
Person authorized by duly executed Power of A,omey 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.
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