HomeMy WebLinkAboutMortgage_Birchler (2) =�, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coon Township Year
FOR DEDUCTION FROM ASSESSED VALUATION � �
7 State Form. 43709(813/10-15) -
�� Prescribed by Department of local Government Finance t_. �.
INSTRUCTIONS: �•�
To be filed in person or by mail. Form Ned with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought. NQ �r ,,�
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is 3I�d�Author
located on or before January 5 of the immediately succeeding calendar year
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County Auditor of the county County Recorder
where the property is boated during the twelve(12)months before March 31 of each year the d
See reverse side for additional instructions and qualifications. N COUNTY A UDl70R
..... 1 v wavhtraCWryar`' l /7 i-cir�x � cod‘-e , j�0n .
T. .: . .A•- Key numhber/legal din Record r;ter Page number
oft -a-351/60 - 0 7o9/-6a� 'co .Y�aPi
• _.value of reef property as of Mortgage/Contract indebtedness unpaid as of • Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,=rent year assessment date,amen year data of applryapor) ri CO legal or equable owner?
.712/OV. ❑ Yes ❑ No
If no,what is his f her exact share of interest? If owned with someone other than•lvn,ca,indicate with whom
If name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
Real Property 0 Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller ��3
q
Address of mortgagee or contract seller(nwnber and street,city,state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage ' _ rh
�2CU LE12/ i
Address of assignee(munber and street why,slate,and ZIPa 861581 , .
Does�t own property in any if yes,what county? - `�^ ^ , � /\ /� quested If yes,state amount of deduction
in Indiana? ❑Yes ONo e7C,Y� /&-5003 / Ohio
A person is not entitled to this deduction unless the per. ndebtedness that is recorded in the county
recorder's office(induddg any home equity fine of cremt mat is recoraeo m me wurny rewn.=a....' ,.ie basis for the deduction.
COUNTY AUDITOR '
Deduction approved in the amount at
20 20 20 20 20 20 20
Signature of CoutyAudew County Date(=rah,day,year)
t/We certify under the penalty of perjury that the above and foregoing intwma&on 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.
1
Signature( hull . :penalty
r,d� Date(month,day,year)
,ll\ r Y�e4�/to<4,
Full 2,.�:-.of ow acrd st a.and code) / y�96,
authorized by duly executed Power ofAttomey�6-1.1-12-0.7 r Date(month,day,year)
Address of authorbead person (number and sheet ofy state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.