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Mortgage_Lynch (2)F STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year j FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R13/10-15) Prescnbed by Department of Local Government Finance INSTRUCTIONS: File Mark To be filed in person or by mail. Form filed with: Filing Oates 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 properly 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 CountyAuditor of the county where the property is located during the twelve(12)months before March 31 of each year the deduction is sought See reverse side for additional instructions and qu Applicant(9NFji r o contract nbuyer- use sMe T ." G&[& Ket rru / -. n r Page tuber IQ rib= a=o - ,3oa-tom• c'O�6 7 / � l Assessed value of real as of ge I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment date,current year a55esunent date,current year date of apprwaa0n // legal Orequiitable owner? - / �t-O 0 Yes 0 No If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom If name on record is different than that of applicant indicate below Is a property in question:Annually Pcwcged Real Property 0 Annually Assessed Mobile Home(IC 6-1.1-7) , Noma N mortgagee or contract seller Address of mortgagee or contract seer(number and ,site,and code) Name of assignee or other owner or holdage N©� 28 ��% 7 '�Q ) Bra'- 10 / 9� v 2°18 Address of assignee(number and street and ZIP code) Glean., Does applicant own property in any If yes•what county? What Taxing District? Has this deduction been requested If yes.`AQ douot&Reduction innIndiaanna?nty ❑Yes ❑No ,cur on rent pertyn' ❑Yes ❑No ^UDITpR 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 reorders 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 I 20 I —on - - 20 Signature of County Auditor year) I/We certify under the penalty of perjury that the above and foregoingo��infi � \ ............• ent of Indiana and owner I contract buyer of the aforementioned property on date applicationaP D 1"���'C I" 1 , Si n r e)ficp /Jea0 l i Card \�. ....Ni. Z�l� lUly�U�d � srate,and LP code) AL Person authorized by Vduy executed Power r of'It or by IC 6-1.1-12-0.7 Date(month,day,year) - Address of authorized person (number and street(iry,state,and ZIP code) The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$f0,000. - - - .---