HomeMy WebLinkAboutMortgage_Heitz STATEMENT OF MORTGAGE OR CONTRA( dNIXT;E
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•af"' q�j � ) County I Township I Year �
re•-,;\ FOR DEDUCTION FROM ASSESSED VALU ON1'` I
1 Sate Form 43709(R;3!10-15) �O+U
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'•' %. nest:bee by Department of Local Government Finance JUL 1 3 I 1
INSTRUCTIONS: File Mark
7o be tiled in person or by mad. 'Four fifth via::
Ring Dates: 1) Rear Property..Must be completed and dated in the calendar year for ity2 _Iir :bo�tieR.
Must be filed or postmarked with the County Auditor or County Re eS ofpMC)cd y tviiere the property is ❑ County.Auditor
boated on or before January 5 of the immediately s�year. I U County Recorder
2) Mobile l Manufacured Homes no(assessed as Real Property Must fle with the County Auditor of the county I
where the property is located during the twelve{72)mont`s before March 37 of each year the deduction is sought.
See reverse side for addtionat rest and•u.5fications.
Aoofi .(owner •arnrad auye see st- .� erieside) J
(C/// /
e suzl Key rum•-r 7 taoal 4.ion Remrc numoer Page numcer
I &b 7a-� 7-9 / OO/. �` ?S da � I l 6'- 14141
Assessed r d real plopety as a Mortgage/Centract iddenteines,unoeid as of Mar:cage r Conrad indebtedness unaaic as at 1/s Pe applicant the sole
assessment aa,e,others year assessment pate,anent year date of apiaricaeon I legal or equitable owner?
i as ❑ No
It no."mat is ns I ter exact snare at interest? It owned with someone Miner than spouse,zlaicate with whom
1 It name on rococo is cfieret than Cut of aoo6bnt,indicate below: l Is the aaopeny in auestor:Annually Assessec
I 3-Real Property ❑ Annually Assessed
Mobile home(IC 6-1.1-7)
IN of mortgagee or co ,feller
I A!tit ate, i f / �/a.. 1 //4..... l '
. •aress i"nor:g_-gee a wi tact seller(utmost aria :ea;ay, tar-,a •`P code) / a
I Name of assignee a otrer owner or Kober d mortgage
i
Address of assignee(ninsoer aril steer,thy,sate.and ZIP cave)
Does aop last own p,•7oeny in any, 11 yes,venal=only? What Taxing District? Ras this ceducttr.been requested If yes,state amount at deduction
ether Gnlrl
I n lnoiace?, UYes ❑Na I I crre�y ar? U I Yes ❑Ne
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 dice(including any home ecuhy line of credit that is recorded in the county recorders office)that is the basis for the deduction.
I COUNTY AUDITOR
Deouction=raved in to amount at
I 20 1 20 ' 20 I 20 I 20 I 20 I 20
l I
Signature of CantyAuator I County I Date(month.day,year)
I
I/We certify under the penally of perjury that the above ant foregoing information is true and correct and that the applicant is a resident of Indiana and
menet/mntract buyer of the aforementioned property on date application is filed.
Signatur rnrl�� Ad ;Date Ryq+�.�1'/l real
Full re ent norms of a sunder and 5 city,Scat na VP woe) ` a de
IF 115 S. rbstm \* grunr vti. /M V767
Person a Wsenzed ay city exacu ed Power of Attorney Joy IC 5-1.1-124.7 124.7 I Date(month,day,year)
I
IAndress ct thatch-zed person (number art street.city,sate.and ZIP code) . .
The penalties for perjury can include imprisonment up to two and a nail years and a fore not to exceed mom