HomeMy WebLinkAboutMortgage_Seibert (5) t a? STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-; FOR DEDUCTION FROM ASSESSED VALUATION
State Fo43709(R13/10-15)
'Cl-
- m1 Prescribed by Department of Local Government Finance
INSTRUCTIONS: _ File Mark
lb be filed in person or by mail. Form filed with
Ring Dates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediatey succeeding calendar year. ❑ County Recorder
2) Mobile 1 ManWactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the properly is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant Kramer awn see onn re side) w �a
Taxing District � 4 /H.�./k, S \�iCM/-Cl_.t.+
Key I legal 1plion Record number Page number
- a,-o it- too - . AgS-oa4 I boo
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment dale,current year assessment date,current year dat of a ication legal or equitable owner?
L.4eep ❑ Yes ❑ No
t row 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,indicate below: - Is the property in question:Annually Assessed
J❑ Rea)Property ❑ AnnualiyAssessed
Mobile Horre(IC 6-1.1-7)
Name of mortgagee a amtr '1 jqn�
Address of martlgagee a au - � l� —lb 13 -4 IL E ib)
Name of assignee or other• Si*C 11;, y� `I? . A- MAY 0 8 2017
Address of assignee(numb a i - . ,' a
Does other county applicant own. ..._ ( V C .F fn relse nt of deduction
in Indiana? ❑Yes . ❑No
A person is not entitled to "— 1- \-1 indebtedness that is recorded in the county
recorder's office(indud nc is the basis for the deduction.
Deduction approved in the a+ iatr:
.5 � � 3 . cCD
20 20 20
Signature of County Auditor Date(month,day,yew)
I/We certify under th- that the applicant is a resident of Indiana and
owner!contract buyer
S'r s hill name Date(month,day,yea,)
are ,
FW13 , Cw s ,, la ) '}.-c ( ?Io (4 et
Person authorized by duly executed Power of Attorney or by IC 6-1A-12-0.7 Date(month,day,year)
Address of authorized person (number and street may,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.-. -