HomeMy WebLinkAboutMortgage_Robling a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
•C- 4,' FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: LE
Filing Dates: Real Property:Must be completed and dated in the calendar year for which the deduction is sought MAR w J � Tth'mait 77w
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the co 'p ,. --- -et-
where -ecorder
the properly is located during the twelve(12)months before March 31 of each year the dedu n I;V �,-
See reverse side for additional instructions and qualifications.
4 9@S`� •UNIT AUDITOR
�1L�con vyer-See 'cti on revers" )
Taxing District fCey�l _ 110.3 Record number a number
►7{I ' -COI. 11-oa 1 11 V(a
Assessed value of real property as of Mortgage I Contract bMebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appticaM the sole
assessment dots,current year assessment date,anent year date 4 of appleatpn legal or equitable owner?
1 ID table
❑ 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 di ferent than that of applicant,indicate below: Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
' Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller n 'i c1 I)
Address of mortgagee or contract seller(number ant yV' ---—'-'
k) ���y • Roil d_ r\ c,�,,a k
Name of assignee or other owner or holder of motto' �,
Address of assignee(number and street city,state,
'CR 000 do ll
Does applicant own property in any If yes,what r i I 'L been requested If yes,state amount of deduCion
other county
in Indiana? ❑Yes 0 N 3 `- t1 ]Yes 0 N
.4 person is not entitled to this deduction unless ure Poca,. ____. frntracl indebtedness that is recorded in the county
recorder's office(mduding any home equity line of credit that is recorded in the county recorder o,,,,,,,•„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 I contract buyer of the aforementioned property on date application is filed.
ignature wnets full name) Date(month,day,year)/�(!A ablin
ul fad 't ,fxan (nu'bet and t,city.state,and ZIP code) 3 '� -1
33y 14 , •
Person authorized by• ,'-,-- •d 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,end ZIP code)
The penalties for perjury can include imprisonment up to Iwo and a half years and a fine not to exceed$10,000.