Mortgage_Newcome 7�. a STATEMENT OF MORTGAGE OR CONTRACT INDDTIDIES_ my Township Year
L ' FOR DEDUCTION FROM ASSESSED VALUATION
_ i State Form 43709(R12/6-14) OCT 26.216
'''�„,,�, Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
.i
To be filed in person or ,-by mail. ', .I n11/0. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for,aW'(ioth• .-a i •t is;r NROR
Must be filed or postmarked with the County Auditor or County RecotderOf r Wcoun where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is 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(owner or contract buyer-see restrictions on reverse side)
DONALD K. NEWCOME AND WILMA J. NEWCOME
Taxing District Key number I legal description Record number Page number
OWENSVILLE 26-17-12-204-000.573-022 aQ, l(a- Ll S S 9
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or'egj'able owner?
75,600 78,500 r 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 theyroperty in question:Annually Assessed
eal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of rt agee or contract seller.
rf. Ord • or v ..e-
Address of mortgagee or contract seller mber and street,Jr/state.and ZIP code)
o le-en
�
Name of assignee or other owner holder of ,ortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in a If yes,what county? What Taxing District? Has this deduction been requested If yes.state amount of deduction
other county y on property for
in Indiana? ❑Yes No 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 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 aforement' , &property on date application is filed.
Signatur wners full me /” Date(month,day,year)
)L mall • . _ .r k l�(� ic e -z--- 10/12/2016
Full resident address of applicant(number and street,city,state,and ZIP code)
. 203 E WARRICK ST OWENSVILLE IN 47665
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.