HomeMy WebLinkAboutMortgage_Pohl (6) ;•tea, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION ,,��,F-1� , q y�I
�'• State Form 43709(R13/10.15) Q �J� r} 1 tC�',,,,,`r`r�' _)Q 1 1
Prescribed by Department of Local Government Finance J « ff "� l 11
INSTRUCTIONS: _ File Mark /Y114 0 ao
To be filed in person or by mail. F led with: r
Filing Oates 1) Real Property the
calendar year for which the deduction is sought —I�I
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is /t_y 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 properly is located during the twelve(12)months before March 31 of each year the deduction is sought
See re side for additional instructions and qualifications. Inns
Applian net marl buyer- onreve side) 1I
TaxingD t 3 `O I
Key number/legal description R n Page number
led71, -19 -24 -7o coo? 0�� -02�— ��
Assessed value of real property as of -Mortgage I Contract indebtedness unpaid as of Mortgage Contract indebtedness id as of Is the ap nt the sole
assessment date,and year assessment date,current year date of pinion \T' legal tile owner?
[- eo 1 11 Q Yes No
If no.what is his/her exact share of interest? If owned with ne other tha(i l�,c� El spouse,indicate with whom
If name on record is different than that of apple ant,indicate below: Is r,d"property in question:Annually Assessed
t_yReal Property 0 Annually Assessed
• \ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ,;`✓i\/AX�,'61' �w I—,`-'AI}`-,\.—/
Address of mortgagee or contract seder(number and �state, ZIP code) .
Name of assignee or otter rnuur nr.nem.,.d rr.w--' FILED
Address of assignee(n /;PoN�, /CAS �7� MAY 9 20199
Does applicant own pre pa/l L ray' O ia/ strict? Has this deduction been requested If yes,state amount of deduction
other county I ! on property
in Indiana? ❑Ye r !oo/cj current y o
A person is not entitle C.� n the persoreseiggippfig y1 that is recorded in the county
recorder's office(inch i 3-A).-
09 the county recorder's office a is fh The deduction.
4TY AUDITOR
Deduction a in the amount ot.
20 20?imi 4\20
20 -e 20 . 20 20
•
Signature of `n /ryQidY ti • (6)(ki,../ 1 � Date(� '/]flcar)' ('Ir
I/We certify under the penal of perjury that the above and foregoinginformation and\'coned and that the applicant resident of Indiana and
�Y 0 rY
kowner l co tract buyer of aforementioned property on date application is filed. lenDate(n?drat day,
F ent a ofapplicant(numberand save;city,sta co
and ZIP d ) 1 . x
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(nrorr{A-d yea 1 a ,
Address of authorized person (number and street city,state,and ZIP code) �� f(///l VV lilt
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.