HomeMy WebLinkAboutMortgage_Elpers (31) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r'* FOR DEDUCTION FROM ASSESSED VALUATI
State Fotm 43709(R13/10-15) ILE
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. JUN 27 2018 Form filed
Filing Dates 1) Real Property Must be completed and dated in 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 property is County Auditor
located on or before January 5 of the immediately succeeding calendar ar.
2) Mobile I Manufactured Homes not assessed as Real Property:Must tt A uditor of the county Courtly Recorder
where the properly is located during the twelve(12)months be(q{g(gmpq vagiiimvjestpxgregititvon is sought
See reverse side for additional instnrctions and qualifications.
Applicant(owriaror tract buyer-see re • - side)
L n l l� ? . nr6 1
axing Key number •••1or R nu a umber
I It'' 00, et-. — In- aQO -002.36r�-0)L -0 90
value of real property as of Mortgage/Contract indebtedness uripd4 as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
date,current year assessment date,current year date date of application legal or equitable owner?
3(-�(�0 ❑ Yes ❑ No
tl no,what is his/her exact share of interest? _r If owned with someone other than spouse,ardiirate with whom
It name on record is different than that of applicant indicate below. Is the property in question:Annually Assessed
0 Real Property 0 AnnuatiyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
,;d(a))10c1 Ma(A.
Address of mortgagee or contact seller(number and street,city,state,and ZIP code) 1�__
Name of assignee or other owner or holder of mortgage EAT Qv S ` O
Address of assignee(number and sheet city:state,and VP code) �;ta. \ •� �°''
-50• 00 \k-L°- 0
Does applicant own properly in any If yes,what county? What Taxing District? Has this deducd /r D- 1
other county on property for
in Indiana? ❑Yes ❑No current y 1
C
A person is not entified to this deduction unless the person has a balance on the person's mortgage or c Cl ` "D
recorder's office(including any home equity Se of credit that is recorded in the county recorder's office) ._ .w me 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.
'9,, re(owners rut name) Date(month,day,yeah
'F + •-nt address of applicant(number and street city,slate,and ZIP code)
•'—4)90 Li g col H "Pot ss -44cubs+-cd f-- Tp q%th'
Person authorized by duly executed Power of Attorney or by IC 6-1.1112-0.7 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 S10,000.