HomeMy WebLinkAboutMortgage_Englert STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
'= State Form43709(R13110-15)
Prescribed by Departrnerd of Local Government Finance
INSTRUCTIONS: .. File Mark
To be filed in person or by mail Form filed with:
Ring Dates 1) Real Property:Must be completed and dated in the calendar year for which the deduction is so
Must be filed or postmarked with the County Auditor or County Recorder of the county where s 0 County Auditor
located on or before January 5 of the immediately succeeding calendar year. • •unty Recorder
2) Mobile 1 Manuf&ured Homes not assessed as Real Property:Must file with the County Auditor of the
Sere the property is located during the twee(12)months before March 31 of each year the dedugs sough
See reverse side for additional instructions and qualifications. "�( 3
Applicant( or con a see re reverse side ' f7?p18
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Key mhmDer I Iegal tlesC7- ed H r ratwrap.?
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/ of‘ -p?0-/7-/dG OOO.aoTo1. Jo/ col, rye' o sok
date,
assessment Assessed of�p� of assessment date,arrant
unpaid as of r Mortgagete ofples on indebtedness unpa 6f°1f al ormtdeeoowner?
/077 ❑ Yes ❑ No
i no,what is his I her exact share of interest? If owned with someone'other than cpnven,indicate with whom
If name on record is different than that of applicant.indicate below. Is the property in question:Annually Assessed
Real Pi opt,ly 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller .
Address of mortgagee or contract seller(number and atte r.;tit �/
•
Name of assignee or other owner or holder of mortgage Drawer 'i > d (
V-101P. 04d.ex)
Address of assignee(number and street,dry,state,and LP r / / 9�
Card NO, f �L.C[7
Does applicant own property in any If yes,what county? •••••••. .'',•• uested If yes,state amount of deduction
other county
in Indiana? ❑Yes ❑No i ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mongeyv,,, ,.....__ debtedness 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)Nat 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 filed.
Signature fullname5/ / Date(month,day,year)
Full incidentaddress of applicant(number and street,city, ,and LP code) "V l r 7
Ai
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 Iwo and a half years and a fine not to exceed S t 0,000.