HomeMy WebLinkAboutMortgage_Pfohl STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
°e` `'' FOR DEDUCTION FROM ASSESSED VALUATION County Township Year
Slate Form 43709(R13110-15) �q
co)
Prescribed by Department of Local Government Finance tl N
INSTRUCTIONS: EIeJgMaPk
To be fled in person or by mail. Form filed with:
Filing Oates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sough NOV 9 2017
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property rs ❑ County Auditor
boated on or before January 5 of the immediately succeeding calendar year. unty Recorder
2) Mobile I Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of till county
where the property is located during the twelve(12)months before March 31 of each year the deduotnst
See reverse side for additional instructions and qualifications f,m Rcf)N CO U ICI T Y AUDITOR
Appfica5Vowner or contract buyer-see restrictions on reverse side) / ✓ n
( o-- S • JJV Pr'{''e� .
Taxing District Key number I legal description V Record number Page number
— ' 02 6, -/9 -1 51 _/ol - ooO . SO7 -o ).4, ab ( a- 85_i
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,anent year date of application legal or equitable owner?
If no,what is his/her exact share of interest? If mimed with someone other � e,s ❑ Yes ❑ No
sp6 whom
wn
If name on record is deferent than that of applicant indicate below. Is the property in question:Annually Assessed
❑,Real Properly ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller( 'tier and street city,state,and ZIP code) / C,.v'k SA 1 `` �-Sf a V-
Gl le.\o ?S C bL\ C o
Name of assignee or other owner or holder of mortgage l ` J -1 ����r 2 C`^'��,�Q ��C.
Address of assignee(number and street city,state,and ZIP code) p t�.� �U t —3 s S
� � 6Sg - o6
Does applicant own property in any If yes,what county? What Taxing District? Has 1 —i-1- Ft
other county , p
in Indiana? yes ❑No current yearn IJ res• U No
A person is not entitled 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 recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved to 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
owner I contract buyer of the aforementioned property on date application is filed.
X Si.natu,• .�= full name) . Date(month,day +)
yea
resident a!. or applicant(number and Vibe&city state,and ZIP e)
P60\s .c ' s - ' ''v ZIP Rode) \--N \—tLycl
by duly executed Power of Attorney or by IC 6-1.1-12-0.7 1 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.