HomeMy WebLinkAboutMortgage_Love STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�:: FOR DEDUCTION FROM ASSESSED VALUATION
�]7. State Form 43709(R13/10-1
`''' Prescribed by Department of Local Government Finance F -IUD
INSTRUCTIONS: File Mark
To be filed in person or by mail ,p() 05 2019 Form filed with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sbtJhht
Must be filed or postmarked with the County Auditor or County Recorder of the county whem the properly is County Auditor
boated on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobde I Manufactured Homes not assessed as Real Property:Must file with the County Au '
where the properly is located during the twelve(12)months before Mardi 31 of each rear UDrTOR
See reverse side for additional instructions and qualifications. G I B5
Appacan or carded buyer-� on reverse side)
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Taxing iKey number/legal description Record number 'Page number
AL,- is - 07 _ 30,? - o00. 59 S _ 02 g
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,arrant year assessment date,current year date of application legal or equitable owner?
66 a -7Go oyes ❑ No
If no,what is his/her exact sham of interest? If owned with someone otheV4han spouse,indicate with whom
tf name on record is efferent than that of applicant,indicate below-.. I Is the property in question:Annually AccPcSed
❑Real Property f l Annr..m.e.^---
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Name of mortgagee or contract seller in 6 23 tipmEs b. LovE
Address of mortgagee or contract seller(number and awe(city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street 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 cou in Indiana? ❑Yes 0 No Current year?on roperty for ❑Yes ❑No
A person is not engird 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
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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 coned and that the applicant is a resident of Indiana and
er/contract er of the aforementioned property on date application is filed.
` ulM �� Dale(month.day,year)
/`Y1 t pp' bet and sloest city,state.and ZI�de) ,
Y 3 a. i ,dt sclio Li a? co 1 o
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 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 S10,000.