HomeMy WebLinkAboutMortgage_Kramer • 4, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
= ,d' FOR DEDUCTION FROM ASSESSED VALUATION
«- s- ry State Form 43709(R12/6-14) ,(_/)'/
S ,.n. �° Prescribed by Department of Local Government Finance v� /
•
INSTRUCTIONS: LLL/// File Mark
To be filed in person or by malt. 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 property i ti C.i. 'I. .;'
located on or before January 5 of the immediately succeeding calendar year. r•I n -ecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought. AUG 11 2015
See reverse side for additional instructions and qualifications.
App6.+nt • er gr contra t buyer- i 4 restrictions on re side)
X1.11...41 .__ - it �l A!., • �!/� !..1. _— rlflni:
Taxing istrict T e num er legal descri yP R t:e per
9 4 % y -I9-3( p' D4-t o L/5$-C.la7 %Sc. I pU�'?' r327-10R
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of I the applicant the sole
March 1,current year March 1,current year date of�icationn legal or equitable owner?
❑ Yes ID No
If no,what is his/her exact share of interest? If owned with eon rower than spouse,indicate 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
6.5 G -- , �!(YY --
Address of mortgagee or contract seller(number and street,city,state,and ZIP Odle) l I`/`^^' ,
Name of assignee or other owner or holder of mortgage 002.9dc,_ D
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 on property for
in Indiana? Yes ID 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 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.
'g ra ) Date(month,day,year)he.
F I Osid t adQress o 6 nt number end t,city,state,and Z code %.1
Person a thorized by duly execu ed Power of Attomey 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.