HomeMy WebLinkAboutMortgage_Fischer (2) . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
! ' :;, FOR DEDUCTION FROM ASSESSED VALUATION IL yP,
. '' State Form 43709(R13/10-15)
' - Presalbed by Department of Local Government Finance
INSTRUCTIONS: Male I4, T 7
lb 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
M u s t be fi l e d or postmarked w i t h the County Auditor or County Recorder of the county w h e r e t h e p r o p e rt y is I • Ei •• ' ..itor
located on or before January 5 of the immediately succeeding calendar year. ' r rJ111c mtyy Re' lei
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor oftSdBS! CO AllDITC'
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.
Appfi ant(owner or contract buyer-see restt'ons o r� -use side)
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-Taking istrict Key nu (• legal•- •- • _ •Record number Pager.,,jet
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Assessed value of real property as of Mortgage I Contact indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment data,current year assessment date,current year date of application legal or equitable owner?
a$JSOD Wes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than vex me,indicate with whom
1
If name on record is different than that of applicant,indicate below Is the property in question:Annually Assessed
eat Property El AnnuallyAssessed
• ���CCCCCC Mobile Home(IC 6-1.1-7)
Name of mortgagee or contra• seller
LL —' - -�
•• - of t gagee or contract seller(number and>beet city,state,and ZIP code)
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Name of assignee or other owner or holder of mortgage
4.
Address of assignee(number and street city,state,and ZIP code) '1
Does Does county own property in any If yes,what county? Mal Taxing District? (/�J / /� /'� 'of deduction
in Indiana? ❑Yes 0 N 0!C) 'yan . 1f 5c 1e1
A person is not entitled to this deduction unless the person has a balance on the f 1�' /� I in the county
recorder's office(including any home equity line of credit that is recorded in the a
COUNTY A S/ g /3 on I
Deduction approved in the amount of.
20 20 20 20_ 2 2�( ✓ O a 20
I I 1
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 aforementioned property on date application is filed.
Sig re( � •VlL`7/-� Date(month,day,year)
6l S
resident dress of app t(number and street city state,and ZIP ) D
I O ) / l F . I `2.S�"S Cs Oa T. O,�'� T>, 97 Z Z
Person authorized by duly 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,slate,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.