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HomeMy WebLinkAboutMortgage_Roesch riSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year �' FOR DEDUCTION FROM ASSESSED VALUATION State Fonn 43709(R13/10-15) �'— Prescribed by Department of Local Government Finance INSTRUCTIONS: File Mark lb be filed in perm or by mail. fi S Filing Dates 1) Real Property.Must be completed and dated in the calendar year for whidr the deduction is sought Must be filed orposimarked with the County Auditor or County Recorder of the county where the prope `'a'dor located on or before January 5 of the i mnediatey succeeding calendar year. U Ft; 0 Cm;u(ljx Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county %111111hh where the pmpedy is located during the twelve(12)months before March 31 of each year the deduction is sough See reverse side for additional instructions and qualifications. �,p AppScarrt(owner lq�yn dryer see m�on reverse ) b /J`/W�� Taring District /v(Q ,OJO ! ILdesaip0on I¢�) &1 O ©UD�TV AI1r11T(1R number Page number KO - -©1 - ybD -b04. 300 -oat ojte 379 . Assessed value of real property as of P Mortgage I Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the soue assessment date,current year assessment date nt y • date of application legal or equitable owner? 0 Yes 0 N If no,what is his I her exact sham of interest? If owned with someone other than spouse,indicate with whom If name on record is ddferent 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 gajaaAat Address of mortgagee or contact seer(number and street,raly,state,and LP code) Name of assignee or other owner or holder of mortgage Address of assignee(number and street,city,state,and 710-- '- (�/�) (�,�/'J Does o irant awn properly in any If yes.what cog ,7\\,Cl• I -, •`^� ` '•••••ton been requested If yes,state amount of deduction in Indiana? ❑Yes ❑No vl ❑Yes ❑No A person is not enbTled to this deduction unless tl. ....••Sorttrad inmiebtedness that is ret:orded in the county recorder's office(including any home equity fine o Ca C d \0. • • that is the basis for the deduction. J 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 under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and owner/contract buyer of the aforementioned property on date application is Red. Signature WE name) / Date(month,day,year) I-?neat1— • of a{ an steer ooy,state.and LP code) P authorized by duly eexrewted 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) .S/LOS 74C14 QtiCASt l Ike 1 T, `'76S • . The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.