HomeMy WebLinkAboutMortgage_Rehlander STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coup Township Year
\_'i FOR DEDUCTION FROM ASSESSED VALUATION
yr :t- eta:.Form 43709(813110.15)
Prescribed by Department of Local Government Finance /
INSTRUCTIONS: I 'ie M-'_
Vb be h7ed in person or by mall. --IF:. :.. :
Frimg Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is AA
Must be f or-postmarked with the County Auditor or County Recorder of the county where the properly d UG 1 County Auditor
located on or before January 5 of the immediately succeeding calendar year. Wounty
2) Mobile/Manufactured Homes not assessed as Real Property"Must hie with the County Auditor of the Recorder
wihem the property is located du ' • the twelve(12)months before March 31 of each year the dedudfah' ht
See reverse side for additional instructions and: ihcations. GIgSOM 4l
Applicant(. a buyer-�.7, ) Cat/ "1 r
Art;k- :. -//i3 3�U (�D�����507 4O j 7on u
•..value of real as of Mortgage/Contract indebtedness unpaid as of . Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date, assessment date,current year date of appfratio/33�CC) 0 ❑ No
If no,what is his t her exact share of interest? If owned wit i someone other than spouse,indicate with whom
If name on records different than that of app&mnt,indicate below. ifs Property in question:Annually Assessed
Lp�Neal Property ❑ AmwaayAssessed
,,�h 46€ / " Mobile Home(IC 6-1.1-7)
Name d mortgagee a contract saner /r/Address of mortgagee or contract seller(number and street,city,state,and dZIP code)
Name of assignee or other owner or holder e '
Address d assignee(number and$beet ray, 21 ) '
Does applicant own property in any If yes,what county? - What Taring District? Has this deduction been requested If yes,state amount of deduction ,
other ❑ia ? ❑Yes ❑No - current t Yes El No
A person is not entitled to this deduction unless the',arena 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 (/'�y �.f (/'�� . - -. _,_,__�•,,w,"y is the bass for the deduction.
Deduction approved in the amount of `-�}'��"�1 -
20_ 20 V /) Q 20_ 20
Signature of County Auditor / I-__3.5 US Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is out anti ....d that the applicant is a resident of Indiana and
owner/•• -. buyer of the aforeme property on date application is filed.
5getaa •. tut
Data(month,day,year)
_.( 411 I/7/7
Fun :A. address of .7N umber ant city,state,and ZIP code) 2 �(
4` ! tit / .S' - /Lfr zce a. �� /.rlrr/L /".-- 2(/G ?V
-arson authorized by duty executed Power of Anomey or by IC 6-1"1-12-0. Date(month,day.year)
Address of authorized person (number and sheet,city state,and ZIP coda)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.