HomeMy WebLinkAboutMortgage_Harnishfeger an STATEMENT OF MORTGAGE OR CONTRACTING County Township Year
' '- FOR DEDUCTION FROM ASSESSED VAL
Y ::v�
�7-?..,..„. State Fonn 43709(R13/10-15)
- Presabed by Department of Local Government Finance
INSTRUCTIONS: QCT 1 6 2.011 _ File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Properly Must be Completed and dated in the calendar year for which thj d-y,..r. is sought
Must be filed or postmarked with the County Auditor or County R-..::: :,-44rt711,- when age property is ounty Auditor
located on or before January 5 of the immediately succeeding ca -.1'11:�,,1TY AUDIT L''' ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Pro pe • /g I i-Me Cot/ y Auditor of the county
whem the property is located during the twelve(12)months ard131 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
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Key number I legal description Record number number
r a(-a3 - dc4- aoc- oo 7129 ore/7 7%9
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitab a owner?
430 60 ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If nave on record is different than that of appbant,indicate below-. Is the property in question:Annually Assessed
• eal Property ❑ AnnuallyAssessed
Mobile Hone(IC 6-1.1-7)
Name of rtgagee or con
W
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Address of mortgagee or contract seller(number and area,city state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,al:state,and ZIP code) , ` (t R I ��� ! �/
N I'r �" C�T� � , G
Does applicant own properly in any If yes,what county? What Taxing District? n (18 rj/" , luctioit
other county Ill'V
in Indiana? ❑Yes ❑No 0
A person is not entitled to this deduction unless the person has a balance on the pen- n l J,"�y`� , ) county
recorders office(including any home equity line of a-edit that is recorded in the count /l,[,,()) 1 il/ M ()
COUNTY AUDri AIL YID
('
Deduction approved in the amount of n (y�AIL) PAIL
/1JN�f r•'
Signature of County Auditor County lll/// IS-1 t
I/We certify under the penalty of perjury that the above and foregoing information is MA A b I I -.aid and
owner I contract buyer of the rementioned p date application is tiled.
Sig a ante) (uate(month day
Full resident address of /Or ia Y�t
app (number ,antl ZIP code)
x 517 S. FP71-frf-( I % 7408,573*. , -141. 4176,3 q
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 510,000.