HomeMy WebLinkAboutMortgage_Reteguin .1
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' � FOR DEDUCTION FROM ASS N
State Fonn 43709(R13!10-15)
- Presorbed by Department of L Gove eM Fine
INSTRUCTIONS: \nj► File Mark
To be filed in person or by mail. Form 1 Form filed with:
Filing Dates: 1) Real Property Must be feted and dated in the cafe ar for ' the deduction is sought
Must be filed or postmark • the County Auditor r of the county where the property is County Auditor
located on or before January succeeding calendar year
2 Mobile/Manufactured Homes not assessed as Real ProCounty Recorder
Properly:Must file with the CopMyAuditor of the county
where the property is located during the hveAn(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
• or conaad buyer- on reverse side)
ri WI-Y‘
Taxes koA . Record 2. -I -le:t,01 - 3 l 0 0 6 Z -oz$ Z013�' 513 Page 1—
!assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage/Contract indebtednggs unpaid as of Is the appli�M the sole
assessment date,current year assessment date,current year date aP tJ legal or equitable amen
C ��i • eg ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned voitt-Tneone oft than spouse,indicate with whom
It name on record is different than that of applicant indicate below in( 't O can\ C r V Pro P )' Annually sse s edJ\ Property 0 Annually Home
6
Mobile Horrte(IC Gf.t-7)
Name of mortgagee or conned seller ` �pT
Address of mortgagee or contract seller(number and sra nd LP code) J p E I!
o fano e \ niEEEEE,JJJ
Name of assignee or other owner or holder of mortgage
DEC 262018
Address of assignee(number and street city,state,an, • - - —
piAns.) RE TEGUSJJ '74+ -
Does applicant own property in any If yes,what ow 'n 1" It ,ate amount of deduction
other county COU7• AUUiUK
in Indiana? ❑Yes ❑No 7 Yes ❑No
A person is not entitled to this deduction unless 1 /g 5 /3 Yact indebtedness that is recorded in the county
recorder's office(including any home equity line at is the basis for the deduction.
Deduction approved in the amount of
20 20 20 20 20 ' 204 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 I contract buyer of the aforementioned property on date application is filet
Signaturre.(owners fait name (/}— Date(month,--IAA
I01
e/ ben ands .o stale,and code) It C.
Rd!resJd 3 G 5 N't�Ul 1 .1nt t yvl 34 144-61.i
Person authorized by duly executed Power of Attorney or by IC -1.1-12-0.7 - Date(month,day,year)
Address of authorized person (number and street city,state,and LP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.