HomeMy WebLinkAboutMortgage_Metzger t:�_r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
,.:_ State Form 43709(R13/10-15) It
Prescribed by Department of local Government Finance IS : 'a.
:e
INSTRUCTIONS: i �"
To be filed in person or by mail. APR F filed with:
Filing Oates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought Q IJ
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is c%dunty 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 a co i , tunty Recorder
where the property is located during the twelve(12)months before March 31 of each year the ri, 0,
See reverse side for additional instruction and qualifications. UNT y AUDIT pR
Apprcant(. `nr contr r
atbuye -see`!sbiris on revs ' )
T g s K Key number l l r Record n r Page number
016-1117/ (7 /, 379--Oa6 ISaa
Assessed value of real property as of I Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year data of 7tbnn legal e ❑
/ No
If no,what is his/her exact share of interest? I If awned with someone other ❑ Yes
er than spouse,indicate with whom
If name on record is different than that of applicant indicate below. I,,s,the property in question:Annually Assessed
t4RealProperty ❑ Annually Assessed
/ `` Mobile Home(IC 6-1-1-7)
Name of mortgagee or contract seller
Address of mortgagee or contact seller(number and ally,state,and ZIP code)
Name of assignee or other owner or holder of ma
Address of assignee(number and street city sta. • t�o I !
. Drawer NO. CCC----//////XXXX
Does applicant own property in any If yes,wha / 1 been requested If yes,state amount of deduction
other county r``.0�
ottercount ❑Yes ❑No (/ .I\ ]Yes ❑NO _
A person is not entitled to this deduction unh
Card(� �' intact indebtedness that is recorded in the county
recorders office(including any home equity . 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 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 afore ntioned property on date application is tiled.
Signature( ..1 nom: Date.(vimrth,day,year)
Pun prt..11----of app,.=-tt number and-.-:• city,state hdd'r'IP code)
Person authorized by duly executed Power of,..mey or by 1�7�-0.7 Date(month,day,year)
Address or authorized person (number and street city,state,and ZIP code)
The penalties for per)ury can include imprisonment up to two and a half years and a fine not to exceed$10,000. •