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HomeMy WebLinkAboutMortgage_Shultz l � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year a Lx' FOR DEDUCTION FROM ASSESSED VALUATION r� �' State Form 43709(R13110-15) Prescribed by DeparlmeM of Local Government Finance 1) INSTRUCTIONS: Fill` laQrkf1 � � To be filed in person or by mail UU FortA tb% . 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 a 0 Court Auditor located on or before January 5 of the immediately succeeding calendar year: Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of Ur where the property is located during the twee(12)months before March 31 of each year the deduction Ls sought C I!Arry�,"Di Tttt See reverse side for additional instructions and qualifications. Appfinn b on reverse side) . Tax" District Key nurMor/legal • Record nu; e r 7 g6 -19 - 10 - 30 a - 000 . 6'5/ - o © , I ' ( 50 Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment date,cuffed year assessment date,current year date of application legal or equitable owner? IO /o, Q6O ❑ Yes 0 N If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom It name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed ❑ Real Property ❑ Annually Assessed • Mobile Home(IC 6-1A-7) Name of mortgagee or contract seller /f Address of mortgagee or contract seller(number a sheet city,state.and_,ZIP f`c000de) . Name of assignee or other owner or holder of mortgage Address of assignee(number and sheet city,state,and ZIP code Does applicant own property in any If yes,what county? - sted If yes,state amount of deduction in Indiaanna? ❑Yes ❑No r � \� I No y A person is not entitled to this deduction unless the Drawer O person btedness that is recorded in the county recorder's office(including any home equity line of credit t / S-U lasis for the deduction. Card NO. l� Deduction approved in the amount at 20 20 20 20 20 20 20 Signature of County Auditor County • Date(month,day.year) • I I certify under the penalty of penury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and er I contract buyer of the aforementioned property on date application is filed. �/ S" rug n Date(month,day,yew) /` Full r 4 address t(n and afy:state,and ZIP code)• `l a I n . /it ., 4—, y 7 GY g 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 sheet racy,slate.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. A