HomeMy WebLinkAboutMortgage_Gries ,,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r FOR DEDUCTION FROM ASSESSED VALUATION
�'% State Form 43709(R13/7675) FILE
Prescribed by Department of Local Government Finance J� ,,,,,(((
INSTRUCTIONS: -
File Mark
To be filed in person or by mail. MAY ' 1 '!
Filing Dater 1) Real Property.Must be completed and dated in the calendar year for whirls the deduction is sought
M u s t be filed or postmarked w i t h t h e County Auditor or County Recorder of the county where t h e property is A , M s y, n. , ..itor
located on or before January 5 of the immediately succeeding calendar year. r
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of tt��GG p x�' 2' my Recorder
where the property is located during the hvehe(12)months before March 31 of each year the derl , rt:P. �C - a •
See reverse side for additional instructions and qualifications.
Applicant(own contrast:buyer-see restrictions reverse side)
id�e
i.'�' 9 ' Key number I Iegal desaiption Record number Page number
1es J aLo-ca - h1 - r' DD - (Oa. a"7(D- 43.4 aoi7 actor
.1 = ,.value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contrail indebtedness unpaid as of Is the applicant the sole
.}.- - date,currant year assessment date,�.JJ te,current year \ date of application legal or equitable oowner?.0 o b res ❑ No
If no,what is his t her exact share of interest? J If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant radiate below: - Is the property in question:Annually Assessed
• Weal Property ❑ AnAAO ua l 6-1.1-7)
Name of mortgagee or contract seller
513
Address of mortgagee or contract seller(number and street city,state,and ZIP code) ,
Name of assignee or other owner or holder of mortgage ,))'an cr 1\r —
Address of assignee(number and street dry,state,and ZIP code) Ca I'd li
Doer county applicant own property in any If yes,what county? What Taxing District? Has� deduction been 2qum.,_ •.. D--5 .Q...• n
in Indiana? ❑Yes ❑No airent year? ❑Yes- 0 N
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved an 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 contract buyer of the -r,rementioned property on date application is filed.
Sig s NO , l Date(month,day,year)
F . . address -... t(number• •street city,Sate,and ZIP code)
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 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. -