HomeMy WebLinkAboutMortgage_Spade .gy STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
;�m (' FOR DEDUCTION FROM ASSESSED VALUATION County Township Year
-' I i4 State Fonn 43709(R12/6-14)
•S ' Prescribed by Department of Local Government Finance
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INSTRUCTIONS:
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. OC T d
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is C1 IrAuditor
located on or before January 5 of the immediately succeeding calendar year. El County/Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
the properly is located during the twelve(12)months before March 31 of each year the deducticGl
See reverse side dditional instructions and qualifications. COUNTY AUO O
Applicant(own- . contractb -r- .son reverse a;..) AUDITOR
_4 •
,f,% 1 „/ -_ _ /
Taxis.Distn. Key n her/legal de - on Record number Page number
7/- ,T ■- -G.5 - 61100. 791 1070/I 3 7 73
Assessed value of real property as of Mortgage/v.. tract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,Current year date of applicaX1r'e 7 owner?legal or equitable owner?
. C� . d0 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Assessed
1�'1'f ��I y„ t, Lssessed
t Y11C l c:.1�1 t. Ir I(ICI(® " use(IC 6-1.1-7)
Name of mortgagee or contract seller /� ,., /o 1 - BEISS,.> llt It " pl l I iilll
Address of mortgagee or contract seller(number and u/street,city,state, ZIP< Your Insurance and Risk Management Soup
Name of assignee or other owner or holder of mortgage
Schae.-1-1\11.Ckna_. P
Address of assignee(number and street,city,state,and ZIP code) (�J"�t
Does applicant own property in any If yes,what county? What Taxir "T�`�-1 deduction
other county /
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balan t '1 the county
recorder's office(including any home equity line of credit that is recorde V 1j—�f'�-
C — Yl
Deduction approved in the amount of:
20 20 20 C, - - - 20
Signature of County Auditor
I I We certify under the penalty of perjury that the above and foregoi 5' O Indiana and
owner I contract b er of the aforementioned property on date appli-
Signature(owner II near') �7 I
`/� Full resident address of applicant(number and street,city,state,and ZIP code) (/�-v
7., crO ^/,. `,t �� Dt Risk Management&Insurance Specialists for Government Entities
1 Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
infoeBl i ssMc Kn ight.com
phone 309 663 1393
Address of authorized person (number and street,city,state,and ZIP code) 2601 E.Empire Street
Bloomington.Illinois 61702-0157 _
The penalties for perjury can include imprisonment up to two and a hall - -