HomeMy WebLinkAboutMortgage_Lindauer (2) a, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS cry 1 Ear ti Year
�. 7. FOR DEDUCTION FROM ASSESSED VALUATION g� 1 1 1�-/1
State Form 43709(813110-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: DEC 11.2 7106
To be filed in person or by mad. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the pope 'j:, '4,717,O dy Auditor ,
located on or before January 5 of the immediately succeeding calendar year. �Rp1���f,� f�
2) Mobile/Manufactured Homes not assessed as Real Property.Must file wdh the County Auditor9'otblr;Coonty-U N— * �ecorder
where the properly is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and• -ifications. •
App6ran in rI 'G'C- var�e!'slde-)
dr-Assessed value Bred properly as of Mortgage/Contract indebtedness unpaid as of • Mortgage I Contract. unpaid as of Is the app6card the sole
assessment date.aslant year assessnmd date,arrant year date of app6cafion legal or equtable owneR
❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse with whom
If name on record is d ffemnt than that of applicant,indicate below. Is property in question:Annually Assessed
• Real Property ❑ NmualiyAssessed .
Mottle Home(IC 6-1.1-7)
Nam of mortgagee or coMact saber / /ci- -
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage '
Address of assignee(number and street ay,state,and ZIP code) I
(747. .
Does appemnt own property in any I If yes,what cot tyt - What Taxing District? Has this deduction been requested If yes,state amount of deduction
other in IMF? ❑Yes ❑No • current year? ❑yes ❑No
I �-T 1 has a balance on the person's mortgage or contract indebtedness that is recorded in The county
C Ross Caa p, ' _36 L}Pt L L , hat is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR " - - •
_
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E kA- 20 20 20 20
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County Date(month,day.year)
I I We certify under the penalty of perjluy,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 one application is filed.,
gnahpe(nwn�� / _v /�
Data(month,day,year)
/ F1� /L address• .0 a��el.criY,'state/.�`/ <,.F.C� t f �(ilig
ly
Person authorized lbyy duty executed Power of Attorney or by IC61.1-12-0.7 f Date(month,day,year)
Address of authorised person (number and sheet ray.state,and ZIP soda)
The penalties for per)ury can include imprisonment up to two and a half years and a fine not to exceed$10,000.