HomeMy WebLinkAboutMortgage_Johanningsmeier STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cour> s ' Year
f_ t FOR DEDUCTION FROM ASSESSED VALUATION
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._'�',`_a4z State Form 43709(R13/10-15)
S`v e. Presalbed by Department of Local Government Finance
INSTRUCTIONS: OCT a • I •
To be filed in person or by mail. Form ..with
Filing Dates 1) Real Properly:Must be completed and dated in the calendar year for which the deduction is sought
Must be filed orpostrnarked with the County Auditor or County Recorder of the county where the property i , lr •••• •-•itor
boated on or before January 5 of the irmnediatety succeeding calendar year. • r i'rMt my Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of agieSAI CO AUDI e
where the property is located during the twelve(12)months before March 31 of each y:- , e deduction is sought
See rave i--7.side for additional instructions and qualifications.
Ap'owner• contract buyery see restrictions on reverse side) , 1 /
al T-•,7 D nu /legal d Record�r ben-r �'S/� o/- ISO- do 9 ' 076/6 odd
Ass�se0
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the apptiam the sole
assessment data,current year assessment date,current year date of application legal or equitable owneR
d&071 an J ❑ Yes ❑ No
If rm,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 bebw-. Is petty in question:Annually Assessed
//p,,' �/J Real Property ❑ Annually Assessed
•—�isv(� all / S Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller l(e
Address of mortgagee or contract setter(number and street city,sta 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
in Indiana?county ❑Yes ❑No on year'? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contact indebtedness that is recorded in the county
recorder's office(including any home equity fine of credit that is recorded in the county recorder's office)that is the basis for the deduction.
(` (���P-X '/
UNIT AUDITOR
ODeduction app ) j Ci KALEy
:71014 4.0f)�GSM EZt7Z
21_ /,r _ 0 20 20 20
Signature of G ' I'' '1�3 County Date(month,day,}ear)
I(y I/We cent., _..__. ..._,._.many.,,Wxur y Ural ule motive aria roregorng 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.
/ Signature(owners fug nam�ee)) Q',(� �r`�9y�" Data(month,day,yea)
YII Fria residentt a�applicant(number adtl street,pity state,and+P code)
1002 Picd.(aw. Ct' 1-kZUA, 7 Xd4 IN Li71P3q
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.