HomeMy WebLinkAboutMortgage_Haubold � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
,;;� county Township Year
' FOR DEDUCTION FROM ASSESSED VALUATION FILE ill
�' State Form 43709(RI3/1415)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be fled in person or by mail. JUL 7 2017 Form filed wits
Ring Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or posbn-arked tvdh the CountyAuditor or County Recorder of the ... 'r - -the ire•- is XI County Auditor ,
located on or before January 5 of the immediately succeeding calendar year. -��r1t1 j NI • ❑ County Recorder poggitht 2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the ..∎V. •Z1.rir,' .1 f
where the property is located during the twelve(12)months before March Gi 8 . !L. .-..yT:4 id
See reverse side for additional instructions and qualifications.
AIM(owner or c o n t r a c t buyer-see=on reve side) -
29-2_01a
Ta m-gDild Key number I legal d ,en Record number Page number
l�la/1'f m ,.,-, a to-//-� a-�s a sus oar u a01 - a a77
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of • Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
asr;PSVred date,anent year assessment date,current year dated application legal or equfable owner?
90 0 cd ❑ Yes ❑ No
If no,what is his I 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
• L:}4caat Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Nave of mortgagee or contract
T%
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Na of assignee or other owner or holder of mortgage • .
Name
•
Address of assignee(number and street ray,state,and ZIP code) .
Does applicant own property in any tt yes,what county? What Taxing District? Has '••gym been requested I If yes,state amount of deduction in Other COUrity On
Indiana? ❑Yes 0 N aai rp -
—
A person is not entitled to this deduction unless the person has a balance on the person's rrel cart/ '
recorder's office(mcludmg any home equriy Gyre of eredt that is recorded of the county recur
COUNTY AUDITOR ' D1-a)l.el. 1\•
l
Deduction approved in the amount of ... .,O `
20 20 20 20 Card 1\70, 3.Th _
•Signature d County AurM.or Cott*. I Dare 1,..�_•,.••••.• .
I Me certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicant is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
Sicyahee(own name)) /� / Date(month,day,year)
>C. ss of applicant/ g`Teel,ally, C v*f
FrA residers dapplcant(naz i and street, state,and ZIP cede)
503N Alt r)17) ,
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12a7 Date(month,day,year)
Address of authorized person (number and street dty 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.