HomeMy WebLinkAboutMortgage_Seib (5) c�; STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION:' Stale Form 43709(R13/10.15) VI I�OV� }\({ 5� 2o1g.
Prescribed by Department of Local Government Finance VI
INSTRUCTIONS: .- File Mark
lb be filed in person or by mail. form fi With:
Dates 1) Real Properly th Must be completed and dated in e 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 County Auditor
located on or before January 5 of the immediately succeeding calendar year. 0 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 Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and quaff-cations.
Tani( m buyer-see on reverse side)
alzkat `1'rtey number/legal description Record number Page number
• 26-19 -3 - 3a -000 .2o c -oo°t . 20 t St-kick
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant the sole
ace wnent date,arrant year assessment date,current year date�kation legal a equ a owner?
• g 6 4O D Yes 0 No
If no,what is his!her exact share of interest? If armed with ne other,4010
an purse,indicate with whom
If name on record is different than that of applicant,indicate belay. U the party in question:Annually Assessed
Property 0 Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller17 Tht. FILED
Address of mortgagee or contract seller(number and street ay..state.and ZIP cadet . _ _ _
Name of assignee a otter owner or holder of mortgage 0 ! b' — 3 `L 3 NOV 7 2018
Address of assignee(number and other city,state,and 2 Drawer NO 7��/
rily4L —((t(rc HSN
Does
applicant own property in any If yes,what county awed CQylky late t t duction
in Indiana? ❑Yes ❑No Card NO. ❑No
A person is not entitled to this deduction unless the, indebtedness that is recorded in the county
recorder's office(including any home equity line oft _. _ , _._._he 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 coned and that the applicant is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
Sig ems) Date(month,day,ye
_ �2� _� 11���) g .
Full 2) e�1�Y�m�fad S of Jv t(namber and street city,l ,"sC4.l. antl LP ) 1 )9-4 n n .
Person authorized by duty executed Power of Attorney or by IC e-1.f-1•2-0-o1.7 I ` S"I 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$10,000.