HomeMy WebLinkAboutMortgage_Pflug (2) .-,� STATEMENT OF MORTGAGE OR CONTRACT I EBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATIO rya c
' State Form 43709(R13/ ent o (J� y� �) a Yl 20 �.�'
Presented by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail JNN] g Form filed with:
Filing Oaten 1) Real Property Must be completed and dated in the calendar year for which gic+tl�o�is sought
Must be filed or postmarked with the County Auditor or County R= f-r of the counffv.here the property is County Auditor
located on or before January 5 of the immediately succe®' ce.,r:k -ar., 0 County Recorder
2) Mobile I Manufactured Homes not assessed as Real Prope 4. t•ps �.Fwj- >. III Auditor of the county
where the property is located during the twelve(12)months before . -• 1-•, ti year the deduction is sought
See reverse additional instructions and qualifications. V Au
rtit
i Key m legal descdp on Record number Page number
Ha
Y o? —07— �0.3 - v oa /SV-006 Zon 2
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Con ebtedness unpaid as of Is the applicant the solo
assessment date,current year assessment dal,current year date of ap legal or equitable owner?
�Q ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than�m,indicate with whom
d name on record is different than that of applicant,indicate below: Is th property in question:Annually Assessed
Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee a contract seller /7,7___fac 2/
Address of mortgagee or contract setter(number and abe)et city,state,and ZIP code)
•
Name of assignee or other owner or holder of e A/
/` a\g'C/V —� —�v , oS�ca .r��y,0 30 ��
Address of assignee(number and street city,slate, nd ZIP code)
, 2711
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
dann on property
Indiana? ❑Yes 0No current year? Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contact 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' 20
Signature of Audiitgr /////////�nn County • Date(month,day,year)
710
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
r/contract buyer of th rementioned property on date application is filed.
Si ppp���mmm c . - Date(month,day,year)
l 4stalF7f,
\(� F r . t /of ••:' t(num -II,Y1 .J d-e)/ zo
Pecs JNthonzed by d '.tied Ir offf AtAttor6-1.7-f2-D.7 �� Dal(mach day,year)
Address of authorized person (number and sheet 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. .