HomeMy WebLinkAboutMortgage_Heimbuecher a., . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
Peg, FOR DEDUCTION FROM ASSESSED VALUATION
• rhvl
State Form 43709(R13/10-15)
..„.....
'`----n2-- Prescribed by Department Of Local Government Finance
INSTRUCTIONS: . • 1 F' - Ma;
To 1;ra filed in person or by mail. ,, ,. iiik
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought Pc-
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly isL C T 2 , S Cou •••‘ ditor
located on or before January 5f the immediately succeeding calendar year. ., ,
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Au • of th ty itt.ounty Recorder
where the property is located during the twelve(12)months before March 31 death
each year the t
See reverse • fry additional instructions and qualifications. N n
....of, a .
Appficant( jcontract buyer-see m ' . side)
. AlUbj7-
(21-11X ./ 46Ciff(?-4%n act
Key number/legal description Record number Page number
Afritel--17-71() 4‘ "" a?- .0 2-C CV/.7C/-dolt( 20/F 7 / 4.
Assessed vabe of real property as of Mortgage/Contr-act indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment dab,current year assessment date,arrant year date of appricatian
/a Jo P2 legal or equitable
owner?
0 Yes 0 No
If no,what is his/her exact share of interest? If awned with someone other than spouse,indicate with whom
•
If name on record is efferent than that of applicant indicate below: try in questiom Annually Assessed
Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract setter
A) e'i IV e d-, Vie d/l O afa../X. MCP
Address of mortgagee or contact seller(nurn r and street city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage .
Drawer NO_ 0 I Sr-
Address of assignee(number and street city slate,and ZIP Dude)
Does applicant own property in any If yes,%what county? Mat Taxing District? Has this c Card NO. ..•.
' .-J. ..ctfg
..
other county on proper
in Indiana? 0 Yes 0 No current y ...
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness mar is feanUcu in............-.,
recorder's office(induding 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 ot
,
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.
Date(month,day,year)
\kTgarrrihnithAoh4 c: ,, iti •
) UN resident addlyVor applicant number and • e,and VP code)
S 7, ()-t 2 r5PIACI /fr 1 int 1191 PA 1 Waal 0
Person authorized by duly executed Power ItAtforney or by IC 6-1.1-12-0.7 Date(month,day.year)
Address of authorized person (number and sheet city,slate 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. .
-
'