HomeMy WebLinkAboutMortgage_Kasprzak ms.- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
. -'= State Form 43709(R13 m0-15) I
Prescribed by Department of Local Government Finance 1HtlL E
INSTRUCTIONS: Ile Mark
lb be filed in person or by mail c p. 9 1 2018 Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction isFsbdtjh& = 1,�
Must be filed or posbnarked with the County Auditor or County Recorder of the county where the property is ):1 County Auditor
located on or before January 5 of the immediately succeeding calendar year
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County A - knit, County Recorder
where the property is located during the twelve(12)months before March 31 of e unhi
See reverse side for additional instructions and qualifications. Cr(( KL101TOR
Tp (owner or a,nUaa buyer-se ysMcdons /
au\ (11 Y
Taxing District Keynumben C�VC1�
R ord number Page number
Aeon 26- .11,31 ='40o coy 4,90- oa 1 d o/S' atx)
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,current year assessment date,=rent year date of application legal or equitable owner?
/3 10000 ❑ Yes ❑ No
If no,what is his r her exact share of interest? If owned with someone other than spouse,indicate with whom
tf name on record is different than that of applicant indicate below Is the property in question:Annually Assessed
❑Real Property ❑ Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or ct setter an -
Address of mortgagee or contract seller(number and sheet,city, and ZIP code) `n ` O� )O\
Name of assignee or other owner or holder of mortgage `/`J •• '
Drawer ( ' ... �C� —
Address of assignee(number and street,4:state,and ZIP code)
Card \O. ...........
Does applicant own property in any If yes,what county? What Taxing District? Ha •,c ,state amount of deduction
other in an? ❑Yes ❑No current yeart' ❑
'ana Yes. ❑No
A person is not enlrHed 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
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!contract buyer of the aforementioned property on date application is filed.
re(owner's full name) Date(month,day,year)
PI de ��
F resident ad at applicant number d street,city,stale,and LP7�c i>,cle ,
r a-606 ic./ r_,� �nirr.rr e ra-.--. 7�—nJ/
Person authorized by duly executed Power of Attorney or by 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$10,000_