HomeMy WebLinkAboutMortgage_Milheiser . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.; ; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
�- Prescribed by Department of Local Government Finance
INSTRUCTIONS: _ File Mark
To be filed in person or by mail. DEeOrifi dr
Filing Dates 1) Real property.Must be completed and dated in the calendar year for Wild;the deduction is sought U I
Must be filed or postmarked with the County Auditor or County Recorder of the county wham the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year
2) Mobile/Manufauured Homes not assessed as Real Property:Must file with the County Auditor of theF,q �.&eserder
where the property is located during the twelve(12)months before March 31 of each year the deducbon'W1 COUNTY
See reverse side for additiony�aalljinsssttrrucctitioonns s/anndqu lineations. AUDITOR
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Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as U Is the applicant the sole
assessment date,cement year assessment date,current year date of applvationot legal or equitable owner?
If no.what is his/her exact share of interest? If owned with someone other' �i ❑ Yes ❑ No
spouse,indicate with whom
If name on record is cafferent than that of applicant,indicate below- Is
property in question Aimua9y Assessed
Real Property ❑ Annually Assessed
Mobile Nome(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(nuC street dry, r,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and •- tails- and,41P code) ,Q
�_ I�-' _ ill n' �( //l.2 ii ly �/�' / /sat�
Does applicant own property in any If >6 - county? 1M11at DistriU? Has this deduction been requested If yes, amount of deduction
other on property for
in Indiana? Yes ❑No cement 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
i
20 20 20 20 20 20 20
Signature of County Auditor 1 County I I Date(month,day,year)
•
n.11/We certify under the penalty of perjury that the abo �r X2.5 -cc�J�- �t t11C. t SC,Y' !l applicant is a resident of Indiana and•III downer!contract buyer of the aforementioned property e'-.
Signature(owner's full name 1 Q �O- I O- l� Date(month.day,year)
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Full resident address of apprxant(number and street dty.state. -ao\-1 _' 1 at R
f 4 0 1 o Inver o q l
Person authorized by a' executed Power of Attorney or by ICs ,6 a01 a 1 C •O C) Date(month,day,year)
Address of authorized person (number and sheet city,state,and
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.