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Mortgage_Spindler STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'°'F"1 FOR DEDUCTION FROM ASSESSED VALUATION n.
State Form 43709(R13/10.15) �..1� C y �h lA
Prescribed by Department of Local Government Finance lJl J V l `
INSTRUCTIONS: File Mark
lb 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 orpostmadced with the Courtly Auditor or County Recorder of the county where the property is tJt County Auditor
located on or before January 5 of the immediately succeeding calendar year. 2
Mobile/Manufactured Homes not assessed as Real ProCounty Recorder
2) Properly:Must file with the County Auditor of the county
where the properly is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or conWact restrictions on rse side)
d to off- ago &\ rU�'S Pl..I{ h� d 1e� Q� ;bC,�C ��
Tardrr 10-^ . ICc�n6 t I 1() \— ` V o—0 oz .S `S-o2 2O `t l 1 utJ� O.
Assessed value of real property as of Q\(6 Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness zid as of Is the applicant the sole
assess l date,current year assessment date,current year date of PPlip(pn Iv Is
w equifa6a owneR
f�`(}" )0 DC) ❑ Yes ❑ No
If no,what is his/her eat share of interest? If owned with eone otherlhan spouse,indicate with wham
If name on record is:resent than that of applicant,indiata below'. Is the prupnty in question:Annually Assessed
❑ Real Property 0 AnnuallyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 4T 1 `_ k
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage FILED
Address of assignee(nut. FEB 2 0 2019
SPsuflzEt�
Does applicant own prop( ' ,/:.�. ` Has this dedu ' n recto bed If le amount of deduction
other county �v�.-iN on current year?
ino ercoun ❑Yes n n� aurenteryf
A person is not entitled N"SSA O 1« lemon's mortiO efbIr tideeddia rditR recorded in the county
recorder's office(induct / unty recorder's office)that is the basis for the deduction.
FR_ a ,,�(� _ JDROR
Deduction approved in the_..__......
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 I contract buyer of the aforementioned property on date application is filed.
Sipgn�a�NJreQ�c `1(1� V� Date(�m7onth,day,yea0 G •
F 1 l l7 J 4n�bw ant sheeZcih:state.arM Z1L'.yro y �ll..� — I _ r 2-f G_ L) rV� — 1 l
Iii
Person authorized by duty executed Power of Attorney or by IC 6-1112-0.7 Date(month,day,year)
Address of authorized person (number and street rip(,state,and ZIP code)
The penalties for perjury can include imprisonment up to Iwo and a half years and a fine not to exceed S10,000.