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d.+^ •at STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION gl s1
L I State Form 43709(R12/6-14) ' _soh 2D
Prescribed 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.
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 County Recorder
2) Mobile/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)
Jake J. Wright
Taxing District Key number/legal description Record_nuart� Page num r�
FT BRANC TWNSHP 26-19-18-302-000.406-026 J<
Assessed value of real property as ol Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
'- March 1;amen year-- __ March 1,wrrent year date of application legal or equitable owner?
78,600.00 155,420.00 -El-Yes 0 No
If no.what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
a Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
German American Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
231 W. Broadway Street Princeton, IN 47670
Name of assignee or other owner or holder of mortgage Address of assignee(number and street,city,state,and ZIP code) APR 2 ✓'201•
Does applicant own property in any If yes,what county? what Taxing District? Has this de V""Tf yes,state amount of deduction
other county
in Indiana? ❑Yes NOest,
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedn tFidt 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:
20 20 20 20 20 20 20
Signature of County Audit r �.r() County Date(month,day,year)
5111,2ZsMi + .2a • 1C1
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.
Si nature er's rue name Date(month.day,year)
04/19/2019
Full r ent address rant(num street Cl)'state,and ZIP code)
3 N Hillc est Dr. Ft. ranch IN., 47648
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$10,000. •