HomeMy WebLinkAboutMortgage_Maurer (12) f g s STATEMENT OF MORTGAGE OR CONTRACT INDEBTFNISL I Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15) SEP 9 2016
Department by Departrne of Local Government Finance
INSTRUCTIONS: File Mark
lb be filed in person or by malt. ', 4.17111 Form filed with:
Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the dad ele: :.Y ��,n
Must be filed or postmarked with the County Auditor or County Recorder of(al t•• ��• e i e property AUDITOR R l 0 County Auditor
located on or before January 5 of the immediately succeeding calendar year. l❑" County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the properly is located dining the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applican (owner or contact buyer-see resbtttons on reverse side)
Key number/legal clesalpftion Record number Page number
a
I• ., . 036- 01a- /Co-k9o0 )a -9,LR 6 - oat y /lo 4,579
• •value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole •
• - -nt date,current year assessment rut yAar o date of application legal or equitable owneowner?(� ❑ 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
Weal Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(comber and bbeet dry,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)
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 on property for
in Indiana? Yes ❑No current year?
El ❑
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 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 date application is filed.
Signature(owners fu8 name) Date(month,day,year)
VI- nuu— 4 l��u�LVi-
Full resident address of applicant(number and street,oily,state,and ZIP code)
363 &w /?o0.5 te b s ic/Y, .ZAv 976sy
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.