Mortgage_Sims (3) •
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d//. '\ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township I Year
/.in, FOR DEDUCTION FROM ASSESSED VALUATION
IT
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° Sate Form 43709(R13/10-15)
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Prescribed by Department of Local Government Finance
INSTRUCTIONS: Jute 1 "
To be filed in person or by mail. girt b e•with:
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 II Co . •itor
located on or before January 5 of the immediately succeeding calendar year. :l 1J?tr7+.1. ty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of Nag-s LO 'IT' A r •I o
where the property is located during the twelve(12)months before March 31 of each year the deduction is so g t. • - •
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Whitney N Sims
Taxing District Key number/legal description Record numbe[, Pa er.
�
Johnson 26-19-31-303-000.252-009 I 5 4.7t lc?
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
166,161.00 ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
It name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
Fl Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Mortgage Masters of Indiana, Inc. ISAOA
Address of mortgagee or contract seller(number and street.city,state,and ZIP code)
501 N C,en Pone e,s E'aes.t.IN I7715
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.city,state,and ZIP code)
Does applicant own property in any It yes,what county? Yvhat Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑yes ❑No current year? ❑Yes ❑No
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/contract buyer of the aforementioned properly on date application is filed.
s/
ignature(ow•el/9n a DaJ mon' day year)
Full resident address of applicai number and street.city.state,and ZIP code)
306 S Race St, -aubstadt, IN 47639
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,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 310.000.