HomeMy WebLinkAboutMortgage_Winkler (2) ,e;- �a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
F.' ' ; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13110-15)
`- Presorted by Department of Local Government Finance TT��
INSTRUCTIONS: -
F ileVV;J
To be filed in perm or by mail. Form tiled with:
Filing Dates: 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought r 11$
Must be flied or postmarked with the County Auditor or County Recorder of the county where the property is EB ° 0-aunty Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ C un ecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county.
where the property is located during the twehe(12)months before March 31 of each year the deduction is
See reve�for additional instructions and qualiifications. Al not lNITY AUDITOR
/Applicant a -see o reverse side) CIBSO
Key number/legal description /� 7 number
Page r_
� 4G� -(/—/J-d614 9 �•0e Joit? ova/� j/)
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,amen year sesvrem date,cement year date of appfiabon legal or equitable owner?
❑ Yes ❑ No
If no,what is S 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 property in question:Annually Assessed
Real Property ❑ Annually Assessed
• Nbbtle Hone(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and sheet ,state,and LP code)
(tame of assignee or other owner or '#€e /I /7 eld.l. /Z-'174-- o
Address of assignee(number and street,city, and ZIP code)
Does applicant own property in any If yes,what county? I What Taxing District? • I Has this deduction been requested If yes,state amount of deduction
other county
in Indiana? -❑Yes 0 N ]No _
A person is not entitled to this deduction unless the, ����7777 1,/) ebtedness that is recorded in the county
recorder's office(including any home equity line of r ��l basis for the deduction.
Drawer NO (l(
Deduction approved in the annum of gq
20 20 2C Card NO 20 20
I I
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 coned and that the applicant is a resident of Indiana and
owner I contract buyer of the aforeme tioned p on date application is filed.
Sfgnabue�. ,..name / Date(month,day,day,year)
Terr-
i �address of / /�0
F applicant tuber an street city,stale, nil ZIP aide)
�Od tW'inc.•rss-r// ZicJe—n /4i '/2/ 7n
Person authorized by duly executed Power of Attorney or 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 perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000. .