HomeMy WebLinkAboutMortgage_Wagner c STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS s Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13110-15) I I
<L- Presalbed by Department of Local Government Finance
INSTRUCTIONS: NOV 7F'lel$c
To be filed in person or by mail. Form filed with:
Fibng Dates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought //11
Must be filed orposbnarlred with the County Auditor or County Recorder of the county where the pro s ' unty Auditor
located on or before January 5 of the immediately succeeding calendar year. NN CCrn�,.��.o
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County AuditoEdDkd1DjEi U NT UI7 on corder
where the properly is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Ap t(ownerorcontact buyer-see restrictions on reverse sdle / (^ ,'I,.,
Ta>on9 District/ I Key !legal tlescrip0on / Record number Page number
I GI - f9-/9 -/00? -coo. ago —0 ), C Aol 36Y
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,current year assessment date,arrrent year date of application legal or equitable ownen
V 7, Do ❑ Yes 0 N
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
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller .
1- . ,�- F C —
Address of mortgagee or contract seller(number and sbeercity,state.and ZIP code) Ct;,(` \oy� �• c� J�
Name of assignee or other owner or holder of mortgage W Qom;V 1�c n-�� �e1y,, ,-C, 10.�c
Address assignee(number and street,city,state,and ZIP Dole) �e t`rJ° ` `��-�1�1 ` v..y�,\Usti
Pr NW. /9 - 3 -to , aIA c a13 lL -3S11 tin. 1�
Does applicant own property in any If yes,what county? What Taxing District? Has this p
in
offer county n ❑Yes ❑No on Pm y. 7- 1- 1 (0 \ -2
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 free of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR -
Dedrxtion 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!contract buyer of the aforementioned property on date application is filed.
Sc Signaale .(owner's Mll name) Date(month,day,year)
I FuA resident of j a// t(number and street,city,state,and ZIP code)
I 17o3 E. S+ra,n 59_ t-or+ &r4nch 12ti '/7& '2
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. _