Mortgage_Weisheit rSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
r:_: ( _-
FOR DEDUCTION FROM ASSESSED VALUATION
state Rpm 43709 R13110-15)
�- • Prescribed by Department of Local Government Finance
INSTRUCTIONS: • File Ma
To be filed in person or by mail. F filed w�fi f
Filing Oates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought. f
Must be filed or postmarked with the County Auditor or County Recorder of the county where the proo�v is (a,ty Au"
located on or before January 5 of the immediately succeeding calendar year. i'4Bqq,�.,, /
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coumyJAr1/ Court Order
where the properly is located during the Mehre(12)months befom March 31 of e year the deduction is sought%% —
See reverse side for additional instructions and quaGficatio . GAr^.
Apprxant it : or contra see 7 on reverse -
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Record number Page
nul4er T: D.,/ .o , v K�ef y nber
-� l leg tlesa s- � lac as
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value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
ti _,date,aurent year anent year date of application legal or
equitable owner?
�. � ❑ Yes ❑ No
If no what is his/her enact share of interest? If owned with someone other than spouse,indicate with whom
If name on record S efferent than that of applicant indicate below. Is the property in question:Annually Assessed
❑'Real Property ❑ Annuay'Assessed
Mobile Home(IC 6-1.1-7)
Narr)gof mortgagee or contract seller
Qrn in • , St2 2 e2n
Address of mortgagee or contract yy comber a a6ret, te, rd LP )
♦ s 4 0039
Marne of assignee or other owner or of mortgage . . .
Address of assignee(number and street,dry,state,and ZIP code)
o�applicant own property in any If yes,what county? What Taxing District? Has��for been requested If yes,state amount of deduction
in Indiana? ❑Yes ❑No cement year? ❑Yes- ❑No
A person is not entailed to this deduction unless the person 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 credit that is recorded in the county recorders office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
•
20 20 20 20 20 20 20
Signature at 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 I contract buyer of the aforementioned property on date application is tied.
Signatu lu9namnt 'wK�1 Date(month,day,year)•Full" of Gant
(number and sheet al c state,and ZIP code)
Hoiq E Wh;+c Dak t n jtla4,bsfndfi Intl g7p5 -
-
Person authorized by duly executed Power of Anomey or by IC 6-1.1-12-0.7 Data(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.