HomeMy WebLinkAboutMortgage_Meyer (8) ,per STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Con Township Year
.. : FOR DEDUCTION FROM ASSESSED VALUATION
ry State Form 43709(R13/10.15)
c . Presrnbed by Department of Local Government Finance ft INSTRUCTIONS: FEB 1 F O ,11g
1,
Td be filed in person or by mail. 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 or postmarked with the County Auditor or County Recorder of the county where the prope ' • n Auditor
located on or before January 5 of the immediately succeeding calendar year rA, hr R
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Audito( pp4Iq OU N- UDI I ORecorder
where the property 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.
Appr5ant(owner or contract buyer-see restrictions on reverse side)
Taxm rsbict ` Key /legal d Record nursrber Page number
7 A6, -/a - 07 - yO/ — DO /. 098 - oJ. 9 1 n`
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant Me sole
•
assessment date,current year assessment date,current year date of application legal or equitable owner?
9 5. go 0 ❑ Yes ❑ No
If no, win
,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,indite below: Is the property in question:Annually Assessed
❑RealProperty ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact sell t
Address of mortgagee or contract seller(number and street city,state,and ZIP code) -
�1S _ -
Name of assignee or other owner or holder of mortgage Z 0 „ --1 I (\�
Address of assignee(number and street city,state,and ZIP code) C�.v- C� ',Pot ` '' `Y
eonVC , _
Does other county pplicant own property in any If yes,what county? What Taxing District; z _c \ . Y deduction
in Indiana? ❑Yes ❑No (S ( S C 'l' O
A person is not entitled to this deduction unless the person has a balance on the i in the county
recorder's office(including any home equity line of credit that is recorded in the county recorders once)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County - Date(month,day,year)
11 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.
r 4-3-.enti Sig '(owner's rum ) "irs.V Date(month,day,year)
a ess of appr t( robe antl f0 sfa e, P code) Z/!G//7 1n ¢�J ri + `176 7d
-erson 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. .