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HomeMy WebLinkAboutMortgage_Halbig (2) . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year . xFOR DEDUCTION FROM ASSESSED VALUATION•-17-. State Form 43709(R13/10-15) Prescribed by Department of Local Government Finance INSTRUCTIONS: qqq File Mark To be filed in person or by mail.Filing Filing 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 ditor located on or before January 5 of the immediately succeeding calendar year. �j 2) Mobile I Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the court C T 1 0901/ antra Recorder 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. Applies or contract buyer-see restrictions on reverse side) • 1 lL_. SJL . sr •1 is I� ll111 . • C� _ —•. II _ Ja/_ I-t_;_c-" C11 .. ,� • _ Taxing sisticl Key : !legal.—."ptau :'.. .nurtiber Page -r . -13 - D(o -30 s -©D • 4,31-00 4 / 1 Li, 3 y Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole assessment date,cement year assessment dgrrent year date of approation legal or equitacte owner? 145D. El 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 S different than that of applicant indicate below. Is the property in question Annually Assessed • Real Property ❑ Annua)yAssessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Address of mortgagee or contract seller(number and&met'ary,state,and ZIP code) Name of assignee or otter comer or holder of mortgage • • Address of assignee(number and street city,slate,and ZIP cc Does applicant awn property in any If yes,what county? rested If yes,state amount of deduction other county 2 I ...... in Indiana? ❑ Dr.').\\' Yes ❑No Cr NO••'" TINo A person is not entitled to this deduction unless the persc dotedness that is recorded in the county recorder's office(including any home equity line of credit iasis for the deduction. Card NO. ........ Deduction approved in the amorml of 20 20 20_ 20 20 20 20 Signature of County Auditor County Date(month,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 aforeme boned property on date application is filed. Signature( eras to ante) Data(month,day,year) %o//°/E-g9/ Full ad of app• ( tuber street city,state,and ZIP code) �.. 02 5 S 49,5) / l37 7 . s svr=/1.gc--c,sec , 4fzby, P authorized by duty executed Power of Attorney or by 1C-6-1.14i-01 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.