HomeMy WebLinkAboutMortgage_Leister s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
"1' _; FOR DEDUCTION FROM ASSESSE ALUATION F 1
�' State Form 43709(R73/10.15) VEL � (� r l I\�, r7 1 A
Presorted by Department of Local Government Fi nce J lJ •L. l 1
INSTRUCTIONS: File Mark
To be filed in person or by mail. F led with:
Filing Oates 1) Real Property Must be completed and dated in lh ender year for which the ded ' is sought
Must be filed or postmarked with the County Auditor or unty Recorder of the county re the property is County Auditor
located on or before January 5 of the immediate&succeeding calendar year. 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 Mardi 31 of each year the deduction is sought
See reverse side for additional insb'uctioons and qualifications.
Ap t(owner or contract buyer --1,� nr �side)
Tann
Key number/legal description n Page r
V--\- . 2b - l8 -1 3 -tioD_--Goo .3S0 -026 . l �o
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the nt the sole •
assessment date,current year assessment date,current year date of application�application legal or unable owner?
OYes ❑ No
If no,what is his I her exact share of interest? If owned wiN `r than spouse,indicate with whom
If name on record is di ferent than that of applicant indicate below Il;th property in question:Annually Accossed
/L-1q(,\Real Properly ❑ AnnualtyAssessed
b • qk-,.. Mobile Home(IC 67.1-7)
Name of mortgag or ccvraact seller
FILAddress of mortgagee or contract seller(mum d s �treet city,state,and ZIP code)
Name of assignee or oterowner or holder of mortgage FEB1 1 2019
\ FCD
Address of assignee(number and street city,state,and ZIP code)
i,.- •amftit
Does applicant own property in any If yes,what county? What Taxing District? Has this dedu-.••_ a';•teem N porleaantialitnt of deduction
countyother in on ptym ■ana ❑Yes D No amenear? Yes D No
A person is not entitled to this deduction unless the person has a balance on the persons 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:
20 20 „Si20 _ 20 20 ' 20• 20
Signature of ,�WY - M1 �_ rs County Date(month=daZ';9
,yt\� �y 5
I/We certify under the penalty of perjury that the above oregoing 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.
XSignature(• 7s• rue name) Date(month,day,year) �]
' \ fir ' _ll 2 - 1\ -19 •
FWI t-- • -}••.c t( ber and city state,and Pcode)
20 3 st n St 1 -t "an - L1r- .L I-1 g'
Person authorized by duly executed Power of Attorney Dray 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.