HomeMy WebLinkAboutMortgage_Loehr sa STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
tr' FOR DEDUCTION FROM ASSESSED VALUATION $�
�^. . State Form 43709(R13/10-15) _� )( n
'.1 Presaibed by Department of Local Government Finance by 1 A .�
Mae
INSTRUCTIONS: 1 File Mark
To be filed in person or by mail. FEB 1 4 Tb0n sled with:
Filing Dates: f) 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 pro•--ty is i County Auditor
located on or before January 5 of the immediately succeeding calendar year. -a • County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of th" -' sp %a•
where the properly is located during the twelve(12)months before March 31 of each year the fi►3sfs@,odTY r1UU I I V H
See reverse side for additional instructions and qualifications.
Applicant er or conbact buyer-see restrictions on reverse )
Taxis • i Key number I legal description Record number Page number
.0 h,-e--e ; 6— f;_.— i 7- 1of - cn3-35i - 021 20i 0613
Assessed value of real property as of Mortgage l Contact indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of I Is the applicant the sole
assessment date,current year assessment date,current year date of application ' I ' OO legal or eq teas ❑owner?
il
No
If no,what is his I 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 the property in question:Annually Assessed
❑Real Prupaty ❑ AnnuaffyAssessed
• Mobile Horrte(IC 6-1.1-7)
Name of rtgagee or contact seller •
Mat u �
Address of mortgagee or contract seller(number and street city,slate,and ZIP code)
v /Name of assignee or other owner or holder of mortgage
//V\`v Addre of assignee number street city,state,and ZI e)
9O;j t - l �Jucky, (Iflce65- 1, J A[ 4-71o70
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? ❑ au Yes ❑No rent year? ❑Yes 0 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 A uditr 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 efoementioned property on date application is filed.
Signs re(., U=s ha nnaame n/ �r ()Al / �J/ Date(month,day,year)
•
Fun 1�oatldres9of )vva ^1,1rr7)�ym/�b/erand scree .state rK At/I--e• el) `-L CO 7D
Person authorized by duly ex'!�xeaitJ',ted Power of Alton or by IC 6-1.1-12-0.7 O 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 S10,009.