HomeMy WebLinkAboutMortgage_Heldt (3) . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Ls+",-.:c- .-•<, .A e FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R13 I 10.15)rnb C{ O n Q '4n 2-0�
Prescribed by Department of Local Government Finance ,V\
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed with:
Fifing 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 Properly 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 instructions and qualifications.
- nt(owner or contact buyer-see on reverse side) ++
Pr � B A-
Taring District Key legal description Record nunftr
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness paid as of Is the applicant the sole
assessment date,current year assessment date,ascent year date of application • legal or equitatle owner?
-4'024130 ❑ Yes 0 No
If no.what is his/her exact share of interest? If owned with someone other trams spouse,indicate with whom
If name on reowd is different than that of applicant,indicate belwr Is property in question:Annually Assessed
r g g ]D L Real PmpeRy ❑ AnnuegHon (IC 6
JIIL YN J ,\0 ii�\ Mobile Hone(IC 61.1-n
Name of mortgagee or contract seller C
Address of mortgagee or contact seller(number and street,c&4 tela&10e) it r'� 21 C1 Gh k - .
jJ- JC ,
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.city,state, eTOUNT Y AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ❑No current year? ❑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 of
•
20 20 20 • 20 ' 20' 20
Signature of 4tritoret&Iit\ .��r1 Cou`/ni�y� _ \ Date(e all �
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I 1 We certify under the penalty of perjury that the above and foregoing informationtrue and correct and that the applicantJ�resieent of Indiana and
owner/contract buyer of the aforementioned prope on date application is filed.
Xeras full norm*,- Da aye
resident ota••,•-.(nu•- nddstreet city�ere, nd ZIP code)
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81� S - ell, n- .in - y�690
Person authorized by duly executed Power of Attorney or by IC e-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.