HomeMy WebLinkAboutMortgage_Heldt (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'= FOR DEDUCTION FROM ASSESSED VALUATION
State Form 63709(R13/10-15) .
Prescribed by Department of Local Government Finance
- INSTRUCTIONS: File Mark
To be fled in person or by mad. - -1�-� _, r
Filing Dates: 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought i
Must be fled or postmarked with the County Auditor or County Recorder of the county where the pro rty' !>f ! .: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 of the co ❑ County Recorder
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is s 0 7 2017 •
See reverse side for a ' at instructions and qualifications.
Appignt(owner aContra -see m_mitl/wis ty�''`�• 1��7(�p
Taxing District Key /legal description 6 t Y ge h aFetr
-ta- 3o4 - D03.3140 - ao11 �aycoO
Assessed value of rea properly as of Contract trWebtedness unpaid as of - Mortgage/Contract' unpaid as of Is the appicant the sole
a..beamgnat date,aarem year assessment dattnrent year date of application legal or equdable owner?
4b0 ❑ Yes ❑ No
If no,what is his I he exact share of interestt tr owned with someone other than spmcm,indicate with whom
If name on record is afferent than that of applicant indicate below: Is the property in question:Annually Assessed
❑ Real Property ❑ Amhuaffy Assessed 1.1-7)
Nana Met of mortgagee or contract seller ee
Mobile Home toctit
Address of mortgagee or contract seer(nwnberand sheet city,state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage '
•
Address of assignee(number and sheet rally,state,and ZIP code) • — �
Does applicant own 7
property in any If yes,what county? What Taxing District? )61 g'Q. '{,`A(.t It dIon
Indiana?other county in ❑Yes ❑No - /�11
A person is not entitled to this deduction unless the person has a balance on the person': Dr a\t:e F N,O 1 V 17 re county '
recorder's office(including any home equfty free of credit that is recorded in the county rf
COUNTY AUDITO !-+ •
Deduction approved in the amount of Card NO. C/
I
20_ 20 20 20_ 20 I 20 I 20 .
Signature of CountyAuddar County Date(math,day,year)
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.
Signature(awne rte) a� (month,day,Ypcad
� i✓rr � � /LLL� 1 , O
Full address or (number and sheet city,state, ZIP code)rterY1
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,yea)
Address of authorized person (number and sheet ay,,slate,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000. _ _