HomeMy WebLinkAboutMortgage_Maurer (3) �, STATEMENT OF MORTGAGE OR CONTRAC I E 1;)- County Township Year
`'`- - FOR DEDUCTION FROM ASSESSED VAL�T N 1
"•.''' �-t•• State Form 43709(R13/10-15) 1
Prescribed by Department of Local Government Finance 206
INSTRUCTIONS: SE? 3 File Mark•
To be filed in person or by mail. , filed with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year .1 . lob .i Sri;,7x.,". is sought
Must be filed or postmarked with the County Auditor or County -_-. . , •.a;'* ../.,� l®Bfe property is a County Auditor
located on or before January 5 of the immediately succeeding Cal.lrt-ANT ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Pro.:nr= le with the County Auditor of the county
where the property Ls located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(gwneigr contract bvyer on reverse side) .
Taxing District Key mrmber I legal description non /
a6- / 9-/5"- ,30 / °a° 07 / O l, `
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,aurentyear assessment date,current year date of application legal or equitable owner?
/0 9100 U ❑ yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
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If name on record is efferent than that of applicant,indicate below. Is the property in question:Annually Assessed
eal Property ❑ Annually Assessed
Mobile Boccie(IC 6-1.1-7)
Name of ee or contract seller •
rvSPD77aM /rem Q/Z/"fl,n)
Address of mortgagee or contract seller(number and street city,state,and ZIP code) __ -
Name of assignee or other owner or holder of mortgage
\M�LA ce Q „ t 4 -\ -
Address of assignee(number and street,city,state,and ZIP code) (//���,p r,,(�r�f� C(r�]//1�(/pJ(��yV 1
Does applicant own property in any If yes,what minty? Wfaf Taxing District? V s-A1 ,, "-4 � �1` 1€i lCOel if deduction
other county
in Indiana? ❑Yes ❑No
aA person is not entitled to this deduction unless the person has a balance on the pc Q- �` /e,,
O l L /O lra6 f in the county
recorders office(including any home equity line of credit that is recorded in the cot. - . - -
COUNTY AUDITOR
Deduction approved in the amount ot.
20 20 20 20_ 20 20 20
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 date application is filed.
S ggna ur name) �����[/) Date(month,day,year)
,�_resdentO! of applicant(number_and saaa4 l 1 'Q/ ZIP code) it �� (�
Person authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 C(/[f' 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.