HomeMy WebLinkAboutMortgage_Reinhart STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
;€:': FOR DEDUCTION FROM ASSESSED VALUATION
*;_.,-. . State Form 43709(R13 I 10-15) Q T bso1 Pt 253\�
."---n— Prescnbed by Department of Local Government Finance
INSTRUCTIONS: _ File Mark
To be filed in person or by mail Fo filed with:
Filing Oates 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
boated on or before January 5 of the immediately succeeding calendar year 0 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.
t(owner or contract buyer-see restrictions on reverse side)
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Taxing District Key number I Record number Page nmer
VI- . Q Ck n� a 1-0 -\ , — S 03- coo.'-k - OQV 201Q1 O
Assessed value of real progeny as of Mortgage/Contract ffidebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year application `or uim a owner?
S I 00 OoD Yes ❑ No
If no,what is his/her exact share of interest? If awned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is I.. .,.._ in question:Annually Assessed
n1 .:rty ❑ Annually Assessed
/ I Mobie Home(IC 6-1.1-7)
Norco:� U!r
contract seller //�/p�/p/
Address of mortgagee or contract seller(number and aut city,state,and ZIP code) 114/
Name of assignee or other owner or holder of mortgageG, r`-'
Address of assignee(number and street city,state,and ZIP code) yeS�N Ca(//yf.Y'.at
AVO/7- .
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,statQihount of deduction
other an on property
in Indiana? ❑Yes ❑No current year? CI 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:
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20 20 20 20 20 ' 20' 20
S' re of County Auditor County - Date(month,day,yewL
1r sz� t Iy l�t`' »n �4 -�9 - 1 'i
I/We certify under the penalty of perjury that the and foregoing information is true and correct and that the applicant is a resident of Indiana and
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owner!contract buyer of the afooremenentioned property on date application is filed.
Signatue)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of aujviized person (number and street city,state,and ZIP code)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. z n