HomeMy WebLinkAboutMortgage_Kron �._ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' FOR DEDUCTION FROM ASSESSED VALUATION ��
State Form43709(R13110-15)
Presabed by Department of Local Government Finance
INSTRUCTIONS: File Ma
To be filed in person or by malt. JAN 2 3 gummed with:
Filing Dates' 1) Real properly.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 pmpe is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Aud. f th=�.-� • � -•ri -- ty Recorder
where the property is located during the twelve(12)months before March 31 of each year the dd6Dft
See reverse side for additional instructions and qualifications. TY AUDITOR
Applicant(owner orcontract buyer see resbicaons prireverse side)
er,j o" Ih . pr. of,
rV� rir' Key numberRe
Taxing I legal description cord number Page number
slueMcalproperty as a eMortg 3indebted /��1 paidazv grtga�kCS-Oa3n ess -) Ora O..SO9 .
•
Assessed unpaid as of Ls the appticant Itie sole
assessment date,current year assessment date,current year date of applicator), legal or equitable owner?
If rio,what is his/her exact share of interest? If owned with 1 eo ��e5 ❑ NO
&ti thanusee.indicate with wham
if name on record is ddferent than that of app6ant,indicate belcwc Is the m question:Annually Assessed
Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller I
crocVA+ ra,cl. - Pty-n rico --
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property For
in Indiana? ❑Yes ❑No current year? ❑yes ❑No
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
recorder's 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 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 n nam arg(mon{�day,year)
am sireetCsiate,and ZIP code) ` .
ill'-\� • `,`,�..JJ. `�r � l C N
erson authorized by duly executed P r of Attorney or by I 6-1.1-12-0.7 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.