HomeMy WebLinkAboutMortgage_Steinmetz , , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS . Township Year
FOR DEDUCTION FROM ASSESSED VALUATION ��� - ���((( — ..! 4/-:\ Stara
Form 43709(R13110-15) - pJ i /7
Prescribed by Department of Local Government Finance pS,
INSTRUCTIONS: ��-C 2 8 2016 File Mark
To be filed in person or by mall Form filed with:
Filing Dates: 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed orposbnarked with the County Auditor or County Recorder of the county ir the •4.-...:is County Auditor
located on or before January 5 of the immediately succeeding calendar year. ..��/'�i�
2) Mobile/Manufactured Homes not assessed as Real Property Must hie with the from •( . : - }IT 0 ❑ County Recorder
where the property is boated during the twelve(12)months before March 31 of ea .-)11;*- reduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or buyer-see resbtedons on verse side)
kbnetenl due 1 /
T aody,D64ict Key number/legal description Record numbe Page
`/ m - 9-19 „200 co/ /'a 8o/?-
Assessed value of rat property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date,parent year •y,®d date,anent year date of application legal or equitable owner?
❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned withsomeone other than spouse,indicate with whom
If name on record is different than that of applicant,Indicate belay. Is the property In question:Annually Assessed
r eal Property ❑ Annually Assesssed
Mobie Home(1C 6-1.1-7)
Name of mortgagee or contract seller
�.T FC U •
Address of mortgagee or contract seller(number and street cdy,state,and ZIP code)
Name of assignee or other owner or holder of mortgage '
Address of assignee(number and street lily,state,and ZIP code) ' I v-- •
Dow applicant own property in any If yes,what county? 5 T LN (' 'G I ANA(
,! 1]If yes,state amount of deduction
in Indiana? ❑Yes El No SUt two o _
A person is not entitled to this deduction unless the person dress that is recorded in the county
recorder's office(rndtidrng any home equity fine of eredit t p❑NBC ( r, DUO°r s for the deduction.
ti Deduction approved in the amount ot. el ALE(/TU fE -&Z-S
20 20 20 20 20 20 20
Signature of County Auditor Caamty Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing infonnafon is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of aforementioned property on date application is filed.
Date(mad),dal:yew)
Full��3 S O , yrc
stoat c 1), N,C.� N L / c,
Person authonoed 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 510,000.