HomeMy WebLinkAboutMortgage_Reinbrecht (2) 4c . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
t•-:'-: FOR DEDUCTION FROM ASSESSED VALUATION
fe State Form 43709(R13/10-15)
�,. Presabed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by maiL Form filed 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 property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. 0 County Recorder
2) Mobile I Manufactured Homes not assessed as Real Property Must file with the County Auditor of the county
where the property 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.
Applicant(owner or contract buyer-see restrictions on reverse side) ,
a . Th Nil C . g Q ,C 1ah.9. Cr t
Taxing District ( Key number I legal description Record number PoegraA
users. ale- \-1-In - aoD .o00 • 1 l�.tk cal zot
Aceosced of real p of M��o{{rt��garrgrreee/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of 1 Is the applicantt a sole
as rw mem date,current year nt date,��.current c of application (legal w^� owner?
eeec���� ins ❑ No
If no,what is his I her exact share of interest? If armed with someone other than spouse,indicate with whom
If nacre on recant is thffe lent than that of applicant,indicate below: Is the property in question:Annually Assessed
Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 11 0 /y1- 1 -N \ kg
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Address of mortgagee or contract seller(number and abeet city,safe.and ZIP code)
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Name of assignee or other owner or holder of mortgage ��1`�j®'of AA 15�9
Address of assignee(number and street city,state,and ZIP code) ``PR K t• 1r \ OR
Igo
Does applicant own properly —.in any If yes,what county? What Taxing District? Has this deduction been requested -If y ,r- ... •eduction
other county on property for
in Indiana? ❑Yes ❑No current year? ❑Yes 0 No �C�0A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedrr�J�t ^crat is recorded in the county
recorder's office(including any home equity line of aedit that is recorded in the county recorders office)that is the basis'&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 cored and that the applicant is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
Signature(owner';full name) Date Qnw,rh,day,year)
u _ . 3—\—F -\9.
Full resident address of applicant(number and street,city,state,�nd ZIP code)
I 5 . 1-I-1� F Cam\ ti t tr_ru--j .i-N • y 7ls g
Person authorized by duty executed Power of Attoney,6r 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$10,000.