HomeMy WebLinkAboutMortgage_Maikranz-Hill } STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
fi .4 FOR DEDUCTION FROM ASSESSED VALUATION �f r�
� State Fonn 43709(R13/10-15) G1L.m� i) ZV 19
`'- Prescribed by Department of Local Government Finance 3 '�t�u
INSTRUCTIONS: File Mark
lb 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.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county ❑ County Recorder
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.
rant(owner or contract buyer-see restrictions on reverse side)
a (-p-h Ana\ llr e-ncrar
Taring District Key number/legal desaiption Record number Pasie number
7?,Q� �C1 a�—�Q - 1�2 — aoo � . 5`Q��► Z�l� 5000
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application owner?Z legal or equitable owner?
Io0 . ❑ Yes El No
If no,what is his/her exact share of interest? If owned with someond 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
Piny 0 finnuanytartan�s A�sed6-1.1-7)
Name of mortgagee or contract seller
'('(\arc.'e_Bi-O-- rtmet \\I-sr'01/4.f1Z_ / �1 /`
Address of mortgagee or contract semen(number /� lY d V
Name of assignee or other owner or holder of mo -
Address of assignee(number and street dry,state,and ZIldtial)0 7 20t9
Does applicant own property in any If yes,what count? District? Has this deduction been requested If yes,stab anxwnt of deduction
other county on property for
in Indiana? ❑Yes El No current yeaR ❑Yes ❑No
1'nn,, (f::9t1l9NTY AUDITOR
A person is not entitled to this deduction unlc� yAfsdn'has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity fine 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 or
20 20 20 20 - 20 ' 20' 20
Sign re of County Auditor Cou ty - to(month,day,yean
�yv � t h o� --1 -; l .
I/We certify under the penalty of perjury the the a 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.
S'• i 44.vmnS full name)4 Date(month,day,year)
Full resident address of app t(mum and s b
p 7F6 Wit: / a_ U/nn / < n /hoiez`
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,stale,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$1 o,of10. • - ..