HomeMy WebLinkAboutMortgage_Maikranz (2) i"'°a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R12/6-14) `
I
,e Prescribed by Department of Local Government FinanceA p n
F I L k 7 r' File Mark
INSTRUCTIONS:
To be filed in person or by mail. �r1 Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for whici AlNdi1'ucti3.yl ought.
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 ye 11 ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file Y.et , pij•l' Vii. or of the county
where the property is located during the twelve(12)months before: . - . = deduction is sought.
See reverse side for ayditional instructions and qualifications. • S U TY AUDITOR
Applicant(owner dr r!-ntact buy r ee rests i 'on/ e ide)
Ta in Dis KeJulnber/lega pi n Record number IPage nuLiD n /� (P-r3-3-06 0-0 6
Assessed value of real property as of Mortgage/Contract
indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,curie t ar date of application legal or equitable owner?
, �SU0 ❑ Yes ❑ No
If no,what is his I 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
Steal Property ❑ Annually Assessed
`1 ��///� /// /V Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller \
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) ,.____
Name of assignee or other owner or holder of mortgage RE M 0 n^
rC rT �
.
Address of assignee(number and street,city,state,and ZIP code) mu2K RA id Z_
Does applicant own property in any If yes,what county? What Taxing District? / — rnt of deduction
other county .
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgayc __- Tied 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 bast, _ a.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 1 20 1 20 20 20 20
Sgnatur f my Auditor County Date(month,day,year)
I/We c-rtify under the.pJenalty of perjury that the above SrSd frKEQoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer/ he aforementioned property on date -.,lication is filed,,-'1
si .a' r' (owner's full na. - II Date(mo th,day,year)Al
Person authorized by duty executed P. er o.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 510,000.