HomeMy WebLinkAboutMortgage_Adler (4) - STATEMENT OIF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION $
State Form 43709(R12/6-14) Al
,04..,' '
Prescribed by Department of Local Government Finance
INSTRUCTIONS: C File Mark
To be filed in person or by mail. FEB 5 0 Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.216
Must be filed or postmarked with the County Auditor or County Recorder of the county w.- - the p •pew ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. I jgvi j;
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the `f4 1:ad -= c�'ULNTOR ❑ County Recorder
where the property is located during the twelve(12)months before March 31 of�- • bon is sought. --
See reverse side for additional instructions and qualifications.
Applicant 'ner or contract buyer-se�tdctions on rgverse e) 3 ^i�
Taxing D' r. Key number/legal descdp` n Record number Page number
��� ait _�3- &_ -yoo m/ t97- oaf / . ire
Assessed%lue of real property as of `'ter Mortgage/Contract indebtedness unpaid as of Mortgage/Contract in ebtedness unpaid as of Is the applicant the sole
March 1.I nent year (March 1,current year date of application legal or equitable owner?
7 800 0 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
1 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 r contra t seller
t/
Address of mortgagee or ntract s Ilex(number and street,city,state,and ZIP code) _
I Name of assignee or other owner or holder of mortgage D L ti-12i -3yy t�-.°1 ny 0 Address of assignee(number and street.city,state,and ZIP code) Rot,\/N Y
Does applicant owm property in any If yes,what county? I What Taxing District? 1 (0 — 11 I f deduction
other county
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person._... _ _. __.__...______..___ ..._.._.___._-_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 I 20
Signature of County Auditor County I 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.
1 I re(owner's full name go/24..a._ Date(month,day,year)
r r resident addr-/of applicant(number and street,city,state and ZIP code)
• D- • - > f�/ uoSfad '17639
1 Person authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 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 S10,000.