HomeMy WebLinkAboutMortgage_Egbert s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'r ' FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13 f 10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: _ , File Mark
To be filed in person or by mail. Form feed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought IT Must be filed or postmarked with the County Auditor or County Recorder of the county where the pmpe I t ❑ u .,� iron
located on or before January 5 of the immediately succeeding calendar year. 11 CCC d, I
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county LJ ecorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought,L 0 5 2018
See reverse side for additional instructions and qualifications. J l/
Applicant orco tart buyer-see restrictions f)
o r i� d 7 r fVI
Taxing D" r�. /l G g-w` �� : UNT` S Y� rR
� � 26 -1 — l�'_102 —d 00 .$02--001- , .goy. 2116
value of real property Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment dale,current Year date of application /r'�r�N°' legal or equitable owner?
q-1' !tvl '— ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with sour other than ipouse,indicate with whom
if name on record is different than that of applicant,indicate below. U perry in question:Annually Assessed
Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller (/'`ry STO V La
Address of mortgagee or contract seller(number and street shy,state,and ZIP code) -_
1� a.
Name of assignee or other owner a holder of mortgage �DrJ�.r� r--0-(\o�'� �r. —
Mrcs.. .y k. �+ tr-A A c _
Address of assignee(number and sheet,city state.and ZIP code) �a\'� t r t`c1 C L.D o v–S Iv C. —
Does applicant own property in any If yes,what county? What Taxing District? Has this dec ■C O _ do l b - `� —
otnraibtrnty ❑Yes ❑No current .. I.CO uO... l� -�-18
in A person is not entitled 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 I contract buyer of the aforementioned property on date application is filed.
Sigua (owm� fuBname) _/ K Date(month,day,year)
F resident address of applicant(number and street city,state,and ZIP code)
A loll we-5,- cc- On k l.,,.d C.;4-y 2- r 14 7(60 _
Person authorized by duly executed Power of Attorney or by IC 6-lA-12-0.7 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$10,000.