HomeMy WebLinkAboutMortgage_Goedde (7) •
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN
' FOR DEDUCTION FROM ASSESSED VALUATIO IL Ile°` Township Year
State Form 43709(Rta/to-15)
Presa3fed by Department of Local Government Finance
INSTRUCTIONS: SU 6 2 16 File Mark
Tb be filed in person or by mail. Form filed with:
Filing Dates 1) Real Property:Must be completed and dated in the calendar year for whidl the ded 's •
Must be filed orposbnarked with the County Audtor or County Recorder of the.• (i -., 1IT+:�y�i{�s aunty Auditor
located on or before January 5 of the immediately succeeding calendar year �al! ' hip( A County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file 1 tbJ (auditor of the county
where the property is located during the twelve(12)months before Marc?n each year the deduction is sought.
See reverse side for additional instructions and qualifications. (//1//)
Appgrant(a or contact buyer-see 1�on reverse side)` / /J y'
•%isirict Key number/legal description Record number Page number
p , a e-.a.3 tee-'91r oi/. soa -o a. c ao/6 a 99 a
�-.-•value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
r• - - date,current year assessment data current year date of application legal or equitable owner?
/,30006 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If aired 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
al Property El AnnualyAssessed
• — Mobile Home(IC 6-11-7)
Name of mortgagee or m seller
rLI- Fe it
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage De0.(..c. 1y �v-v` t \
Address of assignee(number and sheet city,state.and ZIP code) �r�f Yr 4$\\E e.f\Y�\dam 2
A"� �J2s \\etc\ CU
Does applicant own property in any If yes,what county? What Taxing District? ruction
in
other ❑Yes ❑NO "E \-30 ,t), U , CJ
A person is not enbiled to this deduction unless the person has a balance on the person's_ t( '- 1(--\`� e county
recorders office(including any home equity line of credit that is recorded in the county rep o,� h -
COUNTY AUDITOF
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 correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sig re owners fuaname Data(month,day,year)
Full r ent address of appfoant(number and street any state,and ZIP code)
>` a 3 9.Z E. I A la r f e in 4-o✓I Pd . 14-a cubsi dd- 1:D\L f176, 39
Person authorized by duly 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.