HomeMy WebLinkAboutMortgage_Przymus STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
i FOR DEDUCTION)FROM FROM ASSESSED VALUATION
State Form 43709(R12/0-14
+ Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark.
To be filed in person or by mail. . 5 I.(l-. 1, I I
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. -
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is S County Auditor
located on or before January 5 of the immediately succeeding calendar year. (/rT Tr-. -J-corder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the co� `�"nil•
where the property is located during the twelve(12)months before March 31 of each year the deduction is O • - • - • I DITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
MATTHEW J. PRZYMUS
Taxing District Key number/legal description Record number Page number
UNION 26-19-18-102-000.042-025/SUNRISE ACRES chi 011 x313
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?
157,900 209,000 0 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
IN Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
HERITAGE FEDERAL CU
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
5388 OLD STATE HWY 66 NEWBURGH IN 47629
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
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 FA 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 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify unde e penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contra •u• -r of the aforer • ed property on date application is filed.
ye at (owner's 11 na-e) / Y Date(month,day,year)
,�(/ FY11 v 06/09/2016 of Full
210 E 7 OaS p• 'BRANCH IN 47648�21Pcede) /
Person authorized by duty 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.