HomeMy WebLinkAboutMortgage_Maier Win,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�h\7l_r= FOR DEDUCTION FROM ASSESSED VALUATION
: (=`",`t" State Form 43709(R12/6-14) ��
•�'Y;;1f + Prescribed by Department of Local Government Finance
INSTRUCTIONS:
File Mar
To be filed in person or by mail. AUG Fo-m�fihdvith:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. i <�IJ
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ' '_ 7 -.order
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor o((�j7yIgg(� ', 7'nljj;
where the property is located during the twelve(12)months before March 31 of each year the deducYrd}f 13�.•�StDU' UDITO
See reverse side for additional instructions and qualifications. R
Appli nt(o or oohed buyer-se tridi on rave side)
I C max. 7f�
L ! •.trio ey n mbar I legal desrxiption Record number Page num
�� ais a OohSao oast
do At /,Y
...value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract i ebtedness unpaid as of Is the applicant the sole
=`1,anent year March 1,dunent year date of applica ,/��///, legal or equitable owner?
.7.
106 ❑ Yes ❑ No
If no.what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name M Is the property in question:Annually Accessed
Q�_ _ C . .,k Cvv t \. ❑ Real Property ❑ Annually Assessed
(/l° `^" Mobile Home(IC 6-1.1-7)
Nan c �sJ` � C-1- * //
1
Add' 'ZIP code)
—
1 — 1S .
Nam
ao 1S — 1acA
Addr
Doe; ,t,L 2- O O c) • ° 6 Taxing District? Has this deduction been requested if yes,state amount of deduction
other on property for
in Inc current year? ❑Yes ❑No
A per. ?lance on the person's mortgage or contract indebtedness that is recorded in the county
recon orded in the county recorders office)that is the basis for the deduction.
COUNTY AUDITOR .
Dedu
20 I 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 aforementioned property on date application is filed.
ture owner's full name) Date(month,day,year)
,,I Mr c,t A A .
Full rest ent address of applicant(number and street,city, ate,and ZIP code)
(0 1a 1,0 /r), no S. { juu. hLdf / Ll?fn3°l
X Person authorized by duly executed Power of Attorney 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$10,000.