HomeMy WebLinkAboutMortgage_Helfrich x. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
t-i` FOR DEDUCTION FROM ASSESSED VALUATION
'. State Form 43709(R13/10-15)
FIT f ' Fri
Prescribed by Department of Local Government Finance H _
INSTRUCTIONS: File Mark
'lb be filed in person or by mail. JUL 2g :
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 property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year J11.... „--,-- —3 %County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditocofrthe couny' rM a
I where the properly is located during the twefra(12)months before March 31 of each year the dedtacInrsi&i7OUN ry AUDITOR
See reverse side for additional instructions and qualifications.
Applica t(owner or contract buyer-see restrictions on reverse side) •
T - District Key number/legal description Record number Page number
Ala-II-3a - /0/ - 000 . /6L - 0 .. /(o /13
value of real property as of Mortgage!Contact indebtedness unpaid as of Mortgage/Contract indebledness unpaid as of Is the applicant the
assessment date,amend year assessment date,current year date of application legal or equitable owner?
750 0 OD ❑ Yes ❑ No
It no,what is his!her exact share of interest? If owned with someone other than spouse,intricate with whom
If name on record is different than that of applicant indicate belovr. Is the property in question:Annually Assessed
❑ Real Property ❑ AnnuallyAssessed
Mobile Hoare(IC 6-1.1-7)
Name of mortgagee or contract seller
s
Address of mortgagee or contact seller(number and street dry, fe,and ZIP code)
Name of assignee or other owner or holder of mortgage Pei rte
-7 &L]KE -r _
Address of assignee(number and street,dry,state,and ZIP code) at tsszE Al
—
Does applicant own properly in any If yes,what county? What Taxing District? Has this deli
other county on property f /4) —//34/
_
in Indiana? ❑Yes ❑No current year
A person is not entitled to this deduction unless the person has a balance on the person's mortgage_.
recorders office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis an ___.
COUNTY AUDITOR
Deduction approved in the amount of
I
20 20 20 20 20 20 20
I
Signature of County Auditor County Date(month,day,year)
I
1/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 I contract buyer of the aforementioned property on data application is filed.
S' re formes full name) Date(month,day,year)
/Y Full resident address of app5an tuber and street city,state,and ZIP code)
•,1 tOLI E \oa55 Nt -\cult IN L- 1( 3q
„N Person authorized by duty eve" ed Power of Attorney or by IC 6-1.1-12-0.7 Dale(month,day,year)
Address of authorized person (number and street dty,state,and ZIP code)
1 ,
the penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. .