HomeMy WebLinkAboutMortgage_Bender STATEMENT OF MORTGAGE OR CONTRACT INDEBT �,
' Fes' FOR DEDUCTION FROM ASSESSED VALUATION - °If' p Township Year
ru ? "y State Form 43709(R13/10-15) J J JL/
Ilk�— Presorted by Department of Local Government Finance 1 ,t U
INSTRUCTIONS: JUL File Mark
To be filed in person or by mail. Form filed with:
Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the dad fi is
Must be filed or postmarked with the County Auditor or County Recorder of the cou crryry County Auditor
located on or before January 5 of the immedratety succeeding calendar yea�,�Re ON COUNTY UDlri OR
2) Mobile/Manufactured Homes not assessed as Real Property:Must file withile'CowltyAuditor of the county County Recorder
where the property 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.
t( or contract buyer-see re on reverse side) (�
1 w-. L� A �! )sac >1 a
Taxing District Key number I legal descript^io�n Record number a number
ern"-0)er z ID- 17 - 3 oC - lei CO Coo L37_ C a I 2018 Pale
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment doe,current year date of application legal or equitable owner?
I 55 o0O ❑ yes ❑ No
u no,what is his I her exact sham of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate belay. Isst the eproperty in question:Annually Assessed
/ Property ❑ Mobile Home(IC 1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street city,state,and ZIP cede) (/C� )I (v•
Name of assignee or other owner or holder of mortgage DCa1\'CI' NO..�6 1 -
Address of assignee(number and street city,state,and ZIP code)
Card NO. 74°1
Does applicant own property in any If yes,what county? What Taxing District? Ha
other county on
in Indiana? ❑Yes ❑NO amen year? U Yes U NO I
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
recorders office(including any home equity line of credit that is recorded in the county recorders 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 Net
Sig tau fuD Date(month,day,year)
n!a/sid Intt(nu�n �� / I/
Full resgertt' of applicant( �aty state.and LP e) 7-
I 0 2 Z Z I o -r`5 id Pac o A/76 "33
th
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(moot;,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.