HomeMy WebLinkAboutMortgage_Krieg (3) —.�sli
–'r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS -County Township Year
£' a FOR DEDUCTION FROM ASSESSED VALUATION
▪ `- State Form 43709(R12/6-14) •
.S „, Prescribed by Department of Local Government Finance FIT LE
INSTRUCTIONS:
File Mark
To be Wed in person or by mail. MAY 2 3 27 L, sled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be Wed or postmarked with the County Auditor or County Recorder of the county where the prop- is M County Auditor
located on or before January 5 of the immediately succeeding calendar year. r •+
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CountyAud��pQ 4 ;161141'tl'�1.1-. County Recorder
where the property is located during the twelve(12)months before March 31 of each year the19A:')'4r.riff:)I♦TY - . : o -
See reverse side for additional instructions and qualifications.
Applica• (• er or contract b e -see restdcfions on reverse side)
41 i• - ___
T. i,s'ct r-y number/legal description Record r numb Page number
a&,.�•t> ; - o 3 - 3 / - a oo - o0 3 . 8i 7_ C2 7 a/0/6 /945--
Assessed value of real p Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,moment year date of application legal or equitable owner?
50006 ❑ Yes 0 N
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
Address of mortgagee or contract seller( umber and street,city,state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage
Addre of assignee(number and street,city,state,and ZIP code)
f 7 .PL-44--e-t- 31 - 1 -io 1.0 fi-
c—
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 , property for
in Indiana? Yes CI No current year? ❑Yes ❑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 1 __. I ____ — I. — 20 20
Signature of County Auditor • —" /(4, Date(month,day,year)
Drawer NO
II We certify under the penalty of perjury that the at a applicant is a resident of Indiana and
owner/contract buyer of the aforementioned prope
` _ Signature ,eds full nam Card N O. / �� 1 Date(month,day,year)
X\
Full resident address of applicant(number and street,city,st ,and ZIP code)
Person authorized by duly executed Power of Attorney a y IC 6-1.1-12-0.7 Date(month,day,year)
Address of au',hor¢ed 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.