HomeMy WebLinkAboutMortgage_Strunk }> STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
:" . ' FOR DEDUCTION FROM ASSESSED VALUATION rrii
�' , State Fonn 43709(R13l 10-15) -{
`' 't Prescribed by Department of Local Government Finance g
INSTRUCTIONS: 9911 File Mark
TO be filed in person or by mail. fl \ Form filed with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is�grtght2 5
Must be filed or postmarked with the County Auddcr or County Recorder of the county whereme property is r County Auditor
located on or before January 5 of the immediately succeeding calendar year. 11 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Audito f the e1c1!Z1' F
where the property is located dining the twelve(12)months before March 31 of each year the •:,old;.,,,, R •,.UC•� —
See reverse side for additional instructions rastrica'ons on reverse side) G10`'QN COI)
Appfxant(owner or contract
1 Q k C%xan7.e
PanKey number I legal description Record number Page number
% 016-i97- 09 3001 00% 3fj9-oa7 cur ik, aRoV
Assessed value of real as of Mortgage I Contact indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
0000 O ❑ Yes ❑ No
If no,what is his l her exact share of interest? If owned with someone other than spouse,indicate with whom
It 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(number'and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage /
Address of assignee(number and street,city,state,and ZIP code) — ---\C
e
Does applicant own property in any If yes,what county? What Taxing District? �.FU^ s,,_\\4. w�
'deduction
other county - _ C„
ii Indiana? ❑Yes ❑No c.�� \ S�a
A person is not entitled to this deduction unless the person has a balance on the pen __ b y Vie county
recorder's office(including any home equity line of credit that is recorded in the county \D S a tl-
COUNTY AUDIT ��'w '010\`O`I , _\U
Deduction approved in the amount of. l�,w� (c 3
T
OU J C)
20_ 20 20 20 rd \1C. 20_ 20
I
Signature of County Auditor County Date(month,day,year)
I 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 aforem- tinned property on date application is filed.
...e. Date(ninth, year)
a resident address of-,.scant n d street dl)'state.and Z/I� e) 1
'yo /8// (P2S4 G Alex. .� -d'L� 41610
person authorized by duly executed Power of Attorney or by IC GAA-12-0.7 / Date(month,day,year)
Address of authorized person (number and sheet 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.