HomeMy WebLinkAboutMortgage_Leukhardt STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
;' 4' FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)Prescribed by Department of Local Government Finance -
INSTRUCTIONS: File Mark
b be filed in person or by mail. Rims filed with:
Filing Oates: 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 properly is ❑ County Auditor
boated on or before January 5 of the immediately succeeding calendar year. ❑'County Recorder
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the properly is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
contract buyer-see resnitions on reverse skle)
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Au:value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current 1 year date of application PPtication legal or equine owner?
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It r what is his/her exact share of interest? If ownedsomeone
with som homer than nsspouse ❑ No
indicate with whomno!
If name on record is different than that of applicant indicate below-. Is the property in question:i. _,
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1, • 1, s c?b$ 1•••'(IC 6-1.1-7)
Name of moRgagee or contract seller
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Address of mortgagee or setter(number and street,ay,state.and ZIP code) 13
Name of assignee or other owner or hold(
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Address of assignee(number and street. �
Drawer NO 0� � - - - - GU3SON CO IC
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Does applicant own properly in an If y ;deduction bee,seqiiested If yes,state amount of deduction
innindiia a? ❑Yes o �('y���}- - y ar?or Yes ❑No
A person is not entitled to this deduct Ca t-(] Nr O. age or contract indebtedness that is recorded in the county
recorder's office(including any home _ _ .. s office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
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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.
Sig r owner's fu0 name) `a il i Date(month,day,year)
F roil address of�appl+ca\nt(n terstreet dry,state,and ZIP cod )
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Person authorized by duly executed Power of Atto or by IC 6-1.1-f 2-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for penury can include imprisonment up to two and a half years and a fine not to exceed$10,000. •