HomeMy WebLinkAboutMortgage_Rexing (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
f' 4 FOR DEDUCTION FROM ASSESSED VALUATION Coin Township Year
--'r State Form 43709(R12/8.14) zoIP
S-' Prescribed by Department of Local Government Finance O
INSTRUCTIONS: File Mark .
To be filed in person or by mail. A. 101 Form filed with:
Fling Dates. 1) Real Property:Must be completed and dated in the calendar year for which the deducJionit ugn
Must be filed or postmarked with the County Auditor or County Recorder of the county wh the property'• ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. t gf11. 'c OtJ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Aud ' • -.0 !• 4)O
where the property is located during the twelve(12).months before March 31 of each year the• %'.:In ught
.See reverse side for additional Applicant(owner or ontract buyerinstructions restric!lons on reverse side) (j\.,^0 N G'
Logan R. Rex in
Taxing District ey number I legal description Record number Page number
26 -22 -15- 300 -000 .054- 02H 10 1 - 4-148
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or eq ' ble owner?
1ZG,262. Ob !"Yes ❑ No
If no,what Is his/her exact share of Interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,Indicate below. Is property In question:Annually Assessed
rt. Real Property ❑ Annually Assessed
Mobile Hone(IC 61.1-7)
Name of mortgagee or contact seller
German AMC(1(Cr Sr---in Cal (p9 .
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city state,and ZIP code)
Does applicant own property Inap y If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county ,--,v on property for
in Indiana? ❑Yes NJ No current year? ❑Yes ❑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 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
owner/contract buyer of the aforementioned property on date application is filed.
Siglrature(owner's MI name) - Date(month,day,yea)
, 1 , - 1 - 11
Full resid tt address of appl (number and street,city``state,and ZIP code)
\2Gn1 nwenS vr11e Roma Nattnb51•p1-1, -s,N y16 °1
Person authorized by duty 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 penury can include imprisonment up to two and a half years and a fine not to exceed S10,000. .
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