HomeMy WebLinkAboutMortgage_Pohl t .,l-r.t yr mVl I UMUC WIN c VIV I RMI.I INUtI3I tUNtSJ Coup Township Year
_ .- _ FOR DEDUCTION FROM ASSESSED VALUATION �1
State Form 43709 par/10-15)
nt o • r
t°�% Prescribed by Department of Local Government Finance V
INSTRUCTIONS: File Mark
To be filed in person or by mail. q� 3 2016 Form filed with:
Filing Dates: I) Real Property:Must be completed and dated in the calendar year for which the deduct sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the prope 1.-- ❑ County Auditor
Iodated on or before January 5 of the immediately succeeding calendar year. 1
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County 11:141_,A, 'A �t f(OR County Recorder•where the property is located during the twelve(12)months before March 31 of each year r.."' sought.
See reverse side for additional instructions and qualifications. CasON
1t
Applicant(owner or contract buyer-see restictions verse side)
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Taxi.0District Key number/legaltl cription Record number Page number
LTa f/a-, X76- a-,2 00 -to 0, 3ts_n1)1 ?*jg--3-9 ao lL- yo03
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of lie/Contract indebtedness unpaid as of Is the applicant the sole
assessment date.anent year assessment dare,current year dated appitoefion legal a 'ui able owner?
fit, C CO CO,O, Yes ❑ No
If no,what is his/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
° Real Property ❑ Motzle H 6-1.1-7)
Name of mortgagee or contract slier /
/
/� 101/P/J 1Pr0 t /}7/JY7z� j p //l%
Address of mortgagee or contract seller(numbera�ji stree3 dty state,and ZIP code)
g 50 4/ktile e/ne to I/tji �I.& 4escc% 1/A a 3U-s--
Name of assignee or other owner or er of mortgage
Address of assignee(number end 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 ONo current year? ❑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.
5 Date(month,/�fa,y,
ne e ` eR cant( 1 ,1Y t/Vl1`r state, /(1v1.� 09/ ' 6/ .2rD/ Co
Full resident address Jd applicant(number and 5reet,city,state,and P e
Person authorized by duty 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.