HomeMy WebLinkAboutMortgage_Vogler 4n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Township Year
. FOR DEDUCTION FROM ASSESSED VALUATION
+ I� State Form 43709(R12/6-14)
•' -,c, , Prescribed by Department of Local Government Finance _,�i_I. _
INSTRUCTIONS: '3!
To be filed in person or by mail. Fo'"ed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. r '7
Must be filed or postmarked with the County Auditor or County Recorder of the county where the propWitii if 2, p County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
Mobile/Manufactured Homes not assessed as Real Property:Must Me with the County Auditor of At county
. where the property is I..ted during the twelve(12)months before March 31 of each year dedu. ;r y.---�,'. J
See reeversoessido for additionalinstruc'ins and qualificationsn r iISSONCOUNTYAUDITOR
( .I uyer-set -stricu reverse r / �\-� Q
.n .' r r L�•C/nr -yyJ/l)• ber/ 'd-scd Lion ( Record number Page number
>•value of real property as of Mortgage/Contract in!=•ness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,wrrent r date of application legal or equitable owner?
(/(X/ _ '6' ❑ Yes El No
If no,what is his/her exact share of interest? If owned with someone other tha(i spouse,indicate with whom
. If name on record is different than that of applicant,indicate below. Is a property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ewe^
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage ��/1 �� ) /q ��,/,/ /j/� g5/17
Address of assignee(number and street city state,and ZIP code) J aiaA4 �'`i�.1 i2,, �
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested I If yes,state amount of dedu
other county , property for
in Indiana? Yes 111 No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR .
Deduction approved in the amount of
20 _I -='n
r --- tyy I 20 20
20
Signature of CountyAU _ att) / Date(month,day,year)I/
We certify unde Drawer NO is true and correct and that the applicant is a resident of Indiana and
owner/contract bi
Signature(owne�r'sI J Date(month,day,year)
q Card NO.
Full resident address of
9CL C ')KO
3.- Persorl,autho by duty executed P< r of Attoy IC 6L7-12 � Date(month,day,year)
CAddrdr'ess/ss 000ff authorized person (number and street,city,state,randdd ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.