HomeMy WebLinkAboutMortgage_Hertal x STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
l S FOR DEDUCTION FROM ASSESSED VALUATION
State Fonn 43709(R13/10-15)
Presalbed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To 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 r,�
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is I J County Auditor
boated on or before January 5 of the immediately succeeding calendar year.
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county County Recorder
where the properly is boated during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
"Pant(owner or contract see restrictions on reverse side
Taring District Key number I legal description Record number Page number
On# °m 2co- /7-08-LyoO - DOD. ay3- 0 JO) q 1306
AssesW ue of raproperty as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date Durant year assessment date,current year date of application legal or equitable owner?
4-9-6afia-os / 96 000 21es ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of appliican,indicate belay.. Is the in question:Annually Assessed
eat Property ❑ Annually Assessed
• Mobile Hone(IC 6-1.1-7)
Name of mortgagee or contract seller • 1{"'1�g
cvq/2,svi Ile— T rtieJetc &,inL Credo' At,cot, FIT y]iJ` nN !
ED
Address of mortgagee or contrail seller(number and slJt?tt dry,state,and ZIP code)
Name of assignee or other ovmer or holder of mortgage MAR 2 9 2019
Address of assignee(number and street dry,state,and ZIP code)Does
CIp OU I AYn .
other applicantap own property in any If yes,what county? What Taxing District? thpr deductionoPertY been req
9PP99
I I yes, Ta Y amou ocdedtarion
nty for
in Indiana? Yes ❑No current year? ❑❑ a Yes ❑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 ot.
20 20 20 20 - 20 • 20' 20
Signature of County Auditor • County - Date(month,day,year)
Lgt AAA t' 'L$n ,t k 6163m 3-29= / 9
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.
X re(owner's fu name) Date(month,day,year)
-eh
r ' ern ad�br(ess q\(app• t/(riyu/m/bber and
t • y�annd LP code) 141
X i 07 I I IOI U( Q )eilcVI` IIf :TN (10
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 310,000. - _