HomeMy WebLinkAboutMortgage_Loesch •�•n FOR DEDUCTION IO MORTGAGE S ED VALUATION INS' (y Township 4•n un Townshi Year
k--: FOR DEDUCTION FROM ASSESSED VALUATION
z State Form 43709(R12/6-14)
7 Prescribed by Department of Local Government Finance
INSTRUCTIONS: OCT 1 5 2015 File Mark
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 t deducti n is bt- �y�,
Must be filed or postmarked with the County Auditor or County Recorder of ' '/ J
property is t3' County Auditor
located on or before January 5 of the immediately succeeding caler)¢ry xe�„ ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Mu he'�NTr�v t r�Ftounty
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications. 7
Applicant(owner or con -et b - -see restrictions on : erse side)
. de ALA, k I O . A. _I
l District f Key number/.f al description Record n ber Page number
li / , Q60- a-�63ba - 43 /4)4' i5 3aa9'
_value of real property as of Mortgage(r�ontract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1r-/ihe t e date of application legal or equitable owner?
. / 'DOT ❑ 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: Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
. len,
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,city,state,end ZIP code)
Does applicant, I ^/ "C '/ ���. District? Has this deduction been requested If yes,state amount of deduction
other nry W�JCt'� tp on property for
in Indiana? / current year? ❑Yes ❑No
A person is not <9 615- ? 11 1 (J on the person's mortgage orc contract indebtedness that is recorded in the county
recorder's offic JOcc�l in the county recorder's office)that is the basis for the deduction.
UNTY AUDITOR .
Deduction apps
20 20 I 20 I 20 20 20 20
Signature of CounryA i r / County ' Date(month Dy,yegr},
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.
tture(ea full name) Date(month,day,year)
side r( dress of ap licant(nu r and street city,state,and ZIP code)
' /U , /- $)/ thmitt-r4,i /A< 1/ 7670
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. -