HomeMy WebLinkAboutMortgage_Fidler (4) •^•,.4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
- FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14)
�' „„ Prescribed by Department of Local Government Finance — ! ! _ ���•
INSTRUCTIONS: i • :L.,_ s '9
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. APR
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is LTY Auditor
located on or before January 5 of the immediately succeeding calendar year. Recorder Cou ty 2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the coun •
where the property is located during the twelve(12)months before March 31 of each year the deductit;SSp
See revers-side for additional instructions and q - ...cations.
ttffJJ COUNTY AUDITOR
AppGs: r; e A•r contract buys see res 'titan rie srd-)
IF �� .� e _,i/ / i49/
T. ' •D,tdct Key nu ber/ gal description Record number Page number
/214C-e2 -' d4 O/,t JOd- 001.//a- da i 03 U/6 //7 9
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,current year date of application legal or equitable owner?
• /x5/ 0U0 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spous2,indicate with whom
If name on record is different than that of applicant,indicate below: Is th property in question:Annually Assessed
Real Property ❑ Annually Accpcaed
`
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller •
Address of mortgagee or contract seller(nu • street,city,state,and ZIP code) 4r-cz) -
Name of assignee or other owner or holder o ortgage / it- -/ )Address of assignee(number and street,city,state,and ZIP code) Oy V
/cam
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? Yes ❑No current year? ❑
❑ Yes III No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded 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
Signature of ••""•• ""• County Date(month,day,year)
I/We o • ..•• CU) d ,1O //.. 7 information is true and correct and that the applicant is a resident of Indiana and
owner/ ••••' ftion is filed.
Signature(r Date(month,day,year)
ur.&.-.,..J' G ----)
Full resident address of applicant(number and street,city,state,and ZIP code)
7( /cog 5 nxcr-r - 5r /2/GnG cTdIL „/(/ 77670
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.