HomeMy WebLinkAboutMortgage_Braun (2) .r. STATEMENT STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14)
„„ Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be tiled in person or by mail. ® :Ro t vith:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sou j�ti. p _
Must be filed or postmarked with the County Auditor or County Recorder of the county where th ro • C` ••unty Auditor
located on or before January 5 of the immediately succeeding calendar year. O❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CountyAuditor of the MI ip 5
where the property is located during the twelve(12)months before March 31 of each year the deduction i�"s364'f.
See/reverse side for additional instructions and qualifications.
Pp�nnl cone r G buyer on reverse side) air
Tadn ia;da FI umber I al descri GISSO number AU 9PaGeanu be
h- 1 -0 -a'bD- c D . �!I-DaS 15 I `TI $
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date c tion legal or equitable owner?
Li k ff ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone tither than spouse,indite 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 mortgagee or contract seller '/e
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,dry, \\(\e_f A. D ,.,t d\\re— L.
Does applicant own property in any If yes,r C..1./.� v Q,tl vW�� B cot`ic,a . for
been requested If yes,state amount of deduction
other county rty for
in Indiana? Dyes ❑NO �=.Y-CO`+ Pd\'.. ( Ir„r" ear? Ill Yes III No
A person is not entitled to this deduction t \ l t v, ge or contract indebtedness that is recorded in the county
recorder's office(including any home equ (a—15- IS a.U l5 - Q y( a office)that is the basis 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
owne /contract buyer of the aforementioned property on date application is filed.
oafs fullaAme) �J/� Date(month,day,year)
yur
sident address of applicant(number and street,city stet rid ZIP co
I1 ► Dg.. Gpos e �176Y
Person thorized by ury executed ower of Attorney or by IC 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.