HomeMy WebLinkAboutMortgage_Frantz STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
rr §r,,,``:i* FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/1415)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: _ File Mark
lb be filed in person or by mail Tut)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 prope Ypp itor
located on or before January 5 of the immediately succeeding calendar year. g —D County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must Me with the County Auditor of the county
w h e r e t h e p r o p e r t y i s located d u r i n g t h e twelve(12)m o n t h s b e f o r e M a r c h 31 of e a c h y e a r t h e d e d u c t i o n i s s o u g h t G 1 7 [U i 0
See reverse side for additional instructions and Qualifications. AU
Applicant(owner or contract buyer-see relvtictions on reverse side)
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Taring District � Key number!legal description IB NT Page -o>p€1R
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Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid of Is the applicant the soli
assessment date,aurent year assessment date,cement year date of application \ legal or equitable ovmer?
dDo ❑ Yes 0 N
If rat,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on read is different than that of applicant,indicate below. Is the in question:Annually Assessed
O'Reat Property ❑ AnnuallyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract ller
oua Q$ r ra O
Address of mortgagee or contract seller(number aM.o^n.. ^a.•
..u of assignee or other owner or holder of rtwrq V
/r Drawer NO..,.,,..
Address of assignee(number and street city,state, fie+.,J \
" \
Does applicant own property in any If yes,whale Card NO. 'been - --- - -requested If yes,state amount of deduction
other
in Indiaana? ❑Yes ❑No _3 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 property on date application is Redd. qa�(
7aedgib knY1 s>r t \i octet,da,year)• mll tber(J state,and ZIP code
D 1 /
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 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.