HomeMy WebLinkAboutMortgage_Rexing (16) ,tea, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
e-, FOR DEDUCTION FROM ASSESSED VALUATION ��g�J
'^ State Form 43709(R13110-15) F-1
Presaioed by Department of Local Government Finance
INSTRUCTIONS: JAN 1 6 2018 File Mark
lb be filed 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 sought ��11
Must be filed or postmarked with the County Auditor or County Recorder of the county, �vh_-ere th p pt County Auditor
located on or before January 5 of the immediately succeeding calendar year. 7.1/ltAU� 0 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property Must file wrifi-flm d yeti he nr R
where the property is located diving the twelve(12)months before March 31 oYea��i'e deductron`is sought
See reverse side for additional instructions and qualifications.
Applicant(mvner.or�.pwhrb1 -ape(11 ,t/ d t
Taxing District /L�1 Key hurt AJma1de4jhphor�'? — 9 0 cap Cja ) o(2.._6 Record number Page number Ya 38-
lZM M7 2 JR -0_ Q-r3rs �en 0, -, l 5 _ i7 a 3 7
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of ortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,amend year assessment date,arnent year date of application legal or equitable owner?
7,54, 704/ ID Yes ID No
If no,what is his 1 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 ptuprsty in question:Annually Assessed
ZIReal Property ❑ AnnuallyAssessed
Mobile Horne(IC 51.1-7)
Name of mortgag tract selleeerr/�/;yy -
`�J, ii 401 ( A _
Address of mortgagee or contract seller(number and street cily,state,and ZIP code) U
Name of assignee or other owner or holder of ngrtgage / ' J1
g3QyAJ /? 0- a Z✓a&nJ I-
Address of assignee(number and street sty,slate,and ZIP code) 1-1-U d , s r
Does applra nt own popery in any If yes,what county? What Taxing District? I(a-07 j 7)
Verona?? ❑Yes ❑No current year? U Yes- u ,
• 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 dedurfion.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 Imo-- /1 I 20_ . I_ 20
ASignature of County Auditor County 140 anz qr,,, yy.�s T _
I/We certify under the penalty of perjury that the above and foregoing information d t��Aim/ A N['�7�-�N, r r`-lX and
owner I contract buyer of the aforementioned property on date application is filed. "`�� %�(ps/--
7 re( me �
43 Fuflresidant address of apprcant(number and street,city city state.and ZIP code) 0‘3�� 5 -725 /.,/ �-
Person authorized by duty exearted Power of Attorney or by IC 6-1.1-12-0.7 - _ rate(u,wrh4 o r.
ay,y ...,
•
Address of authorized person (number and street dry,state,and ZIP code)
The penalties for perjury can include imprisonment up to twn and a half years and a fine not to exceed$10,000. .