HomeMy WebLinkAboutMortgage_Sollman (13) xr STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Year
it :' FOR DEDUCTION FROM ASSESSED VALUATION
�- State Form 43709(R13110-15) ��f ! t
t '
• -• Presented by Department of Local Government Finance
INSTRUCTIONS: DEC 2 Wi PWPr
To be filed in person or by mail. Form 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 orposbnaf iced with the County Auditor or County Recorder of the county where the County Auditor
located on or before 2) Mobile I Manufactured Homes 5 of the immediately not ssessed as Real Property:Must file with the County Au Pr�
NT f P. pupil Recorder
adhere the property is located during the hvetve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and quaficatons.
t(owner or contras buyer-see resbicdons on reverse side
T-.4 District Key number r legal description Record number Page number
&4-;33 DQ - /oo -oo/• 3 -0441 /(o 30o7
mof real property as of Mortgage/ indebtedness unpaid as of of /Contract indebtedness unpaid as of Is the applicant the sole
application legal or equable owner!
5O o0D ❑ Yes ❑ No
If no,what is his I 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 the property in question:Annually Assessed
1R1 sal Property ❑ Annual'Assessed
Mobile Home QC 6-1.1-7)
Name of mortgagee or contact serer /,
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage _
Add of assignee(number and street city,state,and ZIP code) S b L L(Y11+tiJ D w A(ep L —
VT Au (.0 • 9 -iii die) 01 .101 A c- NTKI1r 4 _
Does applicant own property in any If yes,what county? What Taxing District? Has ft
other on pr)
in Indiana? Yes ❑No curter I to -' !l 300 _
A person is not entitled to this deduction unless the person has a balance on the person's mow._ _ vV- 1 y
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis ro are -...
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 I contract buyer of the aforementioned property on date application is filed.
Signature(owner's fun name n Date(month,day,year)
/Full resident address of app5cant(number a,ccity,stale,and ZIP code)
120 -3 t . 1Z ealc fig a i:, t rl ) te7c,39
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
cSAddress of authorized person (number and street city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a hat years and a fine not to exceed S10,000. -