HomeMy WebLinkAboutMortgage_Herman �> STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cor $ �oi Year
�- 1
't .�,�. FOR DEDUCTION FROM ASSESSED VALUATION
'-. State Fonn 43709(R13/10-15)
�- Prescribed by Department of Local Government Finance
INSTRUCTIONS: MAR gl9411.017
b be filed in person or by mail. 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 Ned or postmarked with the CountyAuditor or County Recorder of the county where the proper0l q{ ' unty Auditor
located on or before January 5 of the immediately succeeding calendar year. 'C.u,wf,�Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with The County Au ditor �eSOrc0UNT uolTxhc-
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side additional instructions and qualifications.
Appfxant(owner or tact buyer'see�r e s u i c d o r�s qn reverse s i d e I er/'l1.M /f�/ymbe
Taring District nu�m-1 O description t-�o -�vW► -11- •g, -o a 1 Rewd1 vY r 52 9
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date,cunent year assessment date,current year da e a i at' legal or equitable owner?
❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is(figment than that of applicant,indicate belay. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller ,I� t�L1�` ('�
Address of nnrtgagee or contact seller(number d ;city state,and ZIP code)
Name of assignee or other owner or holder.of mortoage _
Address of assignee(number and stem
Does applicant own property in any Drawer NO. ..67`0 ( his deduction been requested If yes,state amount of deduction
other county opeity for
in Indiana? ❑Yes ❑No nt year? ❑Yes ❑No
-
A person is not entitled to this dedt Card `r O. 5 acs Or rtgage or contract indebtedness that is recorded in the county
recorder's office(including any hoc //l /� ,/I tI J� en's office)that is the basis for the deduction.
Deduction approved in the amount of. a /v � / V 06
20 20 20 �Y�WYY 20 20 20 20
Signature of County Auditor County Date(month,day,year) •
I 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/contract buyer of the aforementioned property on date application is filed.
,Cre(gwpers R. �e A N(&Q ^ f}�\��-^ f/'�f�- Date(month,day,year)•
ri resident address of K VII [�OD/s�(n n4er and�M`+ 1da� �+Vi `,d a) 1 Wv \ �./�l 7c n
Person authorized by duty executed Power of Attorney or by I 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.