HomeMy WebLinkAboutMortgage_Goedde (2) a„ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Year
��� FOR DEDUCTION FROM ASSESSED VALUATION
;"aR'Z State Form 43709(R13/10-15)
- Prescribed by Department of Local Government Finance
INSTRUCTIONS: - APR 2 3 8*rlc
To be filed in person or by mail. Form filed with:
Filing Dates 1) Real Property:Must be completed and dated fn the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the. .,1•n 's v tt� County Auditor
located on or before January 5 of the in rnediately succeeding calendar year. I if r•
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County AuaalE S@ NTY A- 14 I k/Retarder
where the properly is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Apeadit toneer or contract buyer-see ' ins on reverse side)
67(l —h.)
Taxing District Key number/lega description Record number Page number
OZ-c -ot_c-twQ14-- d / 7 - jd -go t –DOO. S9y-0d- a– 0101 5Y9Y
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
m
assessment date,current year assessment date,anent year date of application legal or equitable owner?
60° OD 0 ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than sbouse,indicate with whom
If name on record is different than that of appfcant,indicate below. Is the •- y in question:Annually Assessed
"tl"ill Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sells / �
Address of mortgagee or contract seller(nu ben and street city,state,and ZIP code) �U / 7 —
Name of assignee or other owner or holder of mortgage _ ��,�
Dratre1- No,
Address of as/�siig-ne�eee'(number and city state,a)nd ZIP code) !-�7 et
Does applicant own property in any If yes,�whar'1 county? District? Ha
Gird fx rQ
other county ,—, ••...
in Indiana? Yes ❑No , w,._._ _ ••..... ,
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or cone....._ my
recorder's office(inducting any home equity line of credit that is recorded in the county recorder's office)that is the basis for u•..
COUNT AU DITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor r'lvmty 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 I contract buyer of the aforementioned property on date application is filed.
.Sig (owner's full name) Date(month,day,year)
ull resident address Mani(number and street city, ,and ZIP code}
pre
S m&,tit 2 Oil ct�L/.Lc-111� 61 7/ 45
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12!1.7 Date(month,day,year)
Address of authorized person (number and sheet 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.