HomeMy WebLinkAboutMortgage_Renck a° . STATEMENT OF MORTGAGE OR CONTRACT IND j S ,," Township Year
'f =�r FOR DEDUCTION FROM ASSESSED VALUATION z I
'.-'-State Form 43709(R13/10.15) J /. t.•:
�- Presorted by Department of Local Government Finance
INSTRUCTIONS: FEB 2 2018 File Mark
To be filed in person or by mail. Form filed :
Filing Dates 1) Real Properly Must be completed and dated in the calendar year for which th deduction is sou
Must be filed or postmarked with the County Auditor or County Recorder of the,dou�yr property is County Auditor
located on or before January 5 of the immedate rng calendar year.�X.JIPPII¢¢�iNN WF.P
2) Mobile/Manufactured Homes not assessed as R al Property:Must® 'Carrify7iadrttorlatha�frnty ❑ County Recorder•
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions qualifications. //�j •^1 `�(��./p�D�/�j
App6rant a�y lecre - on revert)t k/11` ter. , , 11 t
`i g 5i t, /(�j/(/{j,lny` nu description /W/[f\ Record n r number
i� 'VC- la crJ doh rb�. 3►s ' C/7 0« 3
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,aurent year assessment date,gape ye3C '^ date of application legal or equitable owner?
�1/�flJ\�JXII/1 ❑ Yes 0 N
Hoe,what is his/her exact share of interest? / If owned with someone other than spouse,mdxcate with whom
If name on record is different than that of applicant indicate below Is the property in question:Annually Assessed
' ❑Real Property ❑ AnnuallyAsssessed Home Mobile Hoe(IC 6-1.1-7)
Name of mortgagee or contract seller If /
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 in any If yes.what county? lAtiat Taxing District? Has this deduction been requested If yes,state amount of deduction
other on property for
in Indiana? Yes 0 N current year. ❑yes- El 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 Ir recorded in the county reoorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount r# O�
(9
pra��eris0..• � zo 20 20 zo
Signet _! County • Date(m
r V.. I4 ' Qd,c7X01<�S.
!1 w Card O• __..re a ''hd information is •- and correct and that the applicant is a resident of Indiana and
owner _..caned property on date application is filed.
S. re, -1 Date(month,day,year)
address of d'pplicant(number and street city state,and ZIP code)
752? LT. S-0 -c S-E. rLj.a,. TN ']71e76
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(finial',day,}mar)
Address of authored 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 S10,000. •
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