HomeMy WebLinkAboutMortgage_Karges (2) a, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court,is,
Year
`' . ; FOR DEDUCTION FROM ASSESSED VALUATION
-, -'' State Form 43709(R13110-15)
�— Prescribed by Department of Local Government Finance 1 F
INSTRUCTIONS: - NO Y t Man 17
To be filed in person or by mail. Fonn filed with:
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 propertx � mSl" Auditor
located on or before January 5 of the immediately succeeding calendar year
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor o� yCOUN A "UK
where the is located during the twelie(12)months before March 31 of each year the deduction is sought
See reverse side for addition ' stnrctions and qualifications.
Applicant •5 contract -see restrictions on )
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T J., . Key number I legal description 0 Record number
�r L7 % _,02_,,,_70,-, our. 639. Ba7 (loy�,
Assessed value of real property of Mortgage 1 Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appri are the sole
assessmerd date,anent year assessment date,current year date of legal or equitable owner?
of
4-d 5- 0 Yes ❑ No
If no,what is his 1 her exact sham of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below. I property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and city, ,VIIP
Name of assignee w over owner or holder at mortgage K
Address of assignee(number and street city,state,arm I,�11'D(n--/Iu�W. •II,,I�. � A"n'_,,, - - _
Does applicant can property in any If yes,what tour V ///f -- ter" seen requested If yes,state amount of deduction
other n Indiana? ❑Yes 0 N /(7. 4(04A cl0q, lYes. 0 N
A person is not entitled to this deduction unless the person nna a _.._. ;tract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount 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
�wtler/contract buyer of the aforementioned property on date application is filed.
V Date(moron.day,Yeah
% t. g��
1 Full�-�/1rV(/esltlelm�adll{ t • ir� i(nu
U. ) t1 and at Ica I'• •11e�
Personn""aa(u;uttorized 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,slate,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.