HomeMy WebLinkAboutMortgage_Ryser a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
't'jFOR DEDUCTION FROM ASSESSED VALUATION
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t State Fonn 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: _ File Mark
To be filed in person or by mail. Form 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 property is 0 County Auditor
located on or before January 5 of the immediately succeeding calendar year. 0 County Recorder
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twehe(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualfications.
Appfran err or contract buyer-see restrictions �j�)� ,.
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T ' Key legal description Record n r Pa e u
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value real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
amwcsment dam,cunerdr assessment date,current year date of application legal or equitable owner?
/v/� 71r 666 ❑ Yes ❑ 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 betwr. Is property in question:Annually Assessed
- - - - Real Property 0 Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller / Ql�y��� . 6 Vz1c - - -
Address of mortgagee or contract seller(number and Mlbet city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
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Address of assignee(number and sheet cry,state,a Z/
Do"--".ant o`property in any I If yes,what county? Mat Taxing District? Has deduction been requested If yes,state amount of deduction
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on
A O/ - -' _ c Trent year?for ❑Yes
G �--"in has a balance on the person's mortgage or contract inde nt slat its erwrdi (he county
re ' O g 's recorded in the county recorders office)that is the b���sssrrrs focthededudmn.""r
Drawer 1N COUNTY AUDITOR NO\i 2 g op
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Card NO. 20 20 zo o
AUDITOR
Signature of County Atha.. •••••••.••••. County - GIB$drlf+(mon1tdax year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicantl is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sig e(own f'u,(➢l ,�e)))--� (�JDDaate(month,day,year)
r F� hkee ss olapp6ggl//((nuJrgbe Y+ybheet.{y/"F1• LP code) / �// //C7/ `i
`IIN /act/6`Lp //VV(("//.�(/! 'G/'1L/. f�l s �� C!/ C/r i+..
Person authorized by duly executed Power of Attorney or by IC 61.t .7 / Date(month,day,year)
Address of authorized person (number and street cy,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.