HomeMy WebLinkAboutMortgage_Ritzert (2) „; . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
•
-1.f• FOR DEDUCTION FROM ASSESSED VALUATION
'• State Form 43709(R13110-15)
�- Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. 1 • '^ ;th:
Filing Dales: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sough
Must be filed or postmarked with the County Auditor or County Recorder of the county where the props : 5 ty Auditor
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 t4 7 q 1 County Recorder
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sorgPt
See reverse side for additional instructions and qualifications.
Apprrant(owner buyer-see on reverse side) •
.
GISSON leA4L- Ty A-p -�rr�I
Taxing District Key number/ "piton Record nu r rag umber
Ri - 1 -no - 400-CD 3198- 091 ( l (, s�
Assessed value of real property as of 1 Mortgage 1 Contract indebtedness unpaid as Mortgage l Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year I assessment date,current year date of yp r tion� legal or equitable owner?
(]�o ❑ yes ❑ No
If no,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,indice ',Saw”- _ _ Is the property in question:Annually Assessed
' ❑ Real Property ❑ Annually Assessed
6th Mobile Hone(IC 0-1.1-7)
Name ofrrorigageeor contract //.I,,
ntract seller Drawer NO.... ..0'
Address of mortgagee or contact seller(number and stn � ^
Card NO. Lt5
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and_.
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other on property for
in Indiana? Yes El No current year ❑Yes ❑No
' 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 line of credit that is recorded in the county recorder's office)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)
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/co buyer of the aforementioned •r••--• on date application is filed.
Signore Inane) /J / 3on a'_e1r)t"?
F tl i ki aa. , a N. " t(nu 1- and„---4 city,state and LP code)
Tn 7 7
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of audN,lied 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.