HomeMy WebLinkAboutMortgage_Burnor (2) cs;, ^'nv STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
d' - Slate Form 43709(R72/614)
•°". , Prescribed by Department of Local Government Finance
i
INSTRUCTIONS: ¢y" F 1"
To be filed in person or by mail. C• g .r •
. filed 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 y.is In County Auditor
located on or before January 5 of the immediately succeeding calendar year. 0 L r 1 9 2018❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deductionis sought.
See reverse side for additional instructions and qualifications. ••� :�
ApptcaM(owner or contract buyer-see restrictions on reverse side) r�':4"7
MICHAEL R. BURNOR/AND JULIA L. BURNOR GIBSON COON: , . ._DITOR
Taxmg q+Atro� KV'Y/ be1 "a/r to= 3 o p—OU a• . a-So —oa /Record Pay@ number
I
ty ,69
Asre d vats of real property as of Mortgage/Contract indebtedness unpaid as of Mange /Contract Indebtedness unpaid as of Is the a cpp4aanntt the sole
March 1. r year `^ March/,current year date of �I n00
0
legal or equitSle
Yes ❑owner?
No
If no,what is his/hera exact share"1Vof Interest? If owned with someone other than sp
ouse,indicate with whom
If name on record is different than that of applicant indicate below. Is theirePerty in question:Annually Assessed
eal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
HERITAGE FEDERAL CU
Address at mortgagee or contract seller(number and street,city,slate,and ZIP code)
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 a If yes,what county? What Taxing District? Has this
deduction been requested If yes,state amount of deduction
other countyfor 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 AUDROR
Deduction approved N the amount of
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify and a penalty of perjury that the above and fore•.' • motion is true and correct and that the applicant is a resident of Indiana and
owner/contra er of the aforementioned property on date pplicati• is filed.
Signature( ) / ��/ �� Date(month,day,year)
/[� / 08/31/2018
4Full resident a s of applicant(number and street,city,state,and ZIP code
10128 PARTRIDGE AVE HAUBSTADT 147639
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Dare(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$10,000.