HomeMy WebLinkAboutMortgage_Miskovic A STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship Year
rya._ ' �V. FOR DEDUCTION FROM ASSESSED VALUATION - 1_}� � �'
Se�+ State Form 43709(R 13/10-IS) DSOr i� I Z01
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail, Form rued with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. �A
Must be filed orpostmarAed with the County Auditor or County Recorder of the county where the property is County Auditor
located on or before January 5 of the immediate&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 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.
Applicant(owner or contract buyer-see restrictions on reverse side)
£dr,.;aril All 1s! o✓iC a SUS0..1) R . Nil sEovIc, a/I,J
Taxing Dicatict Key number/legal description Record number Page number
Ft � l, - 19 - Iq - c) 0 - 001 . >as- 0�tr 19-01(340
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant Me sole
assessment date.anent year assessment care,current year date of application legal or equitable owner?
ID-7 , Con. 00 Er Yes ❑ No
If no.what is his/her exact share of interest? If owned with someone 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
[}Real Property ❑ Annually Assessed
Mobde Home(IC 6-1.1-7)
Name of mortgagee or contract seller FILED
7F�P RI Na !;rn« I fxznk r�0 (ct (M(
Address of mortgagee or contract seller(number and street.city.state.and ZIP code)
Name of assignee or other owner or Odder of mortgage JUN 1 4 2019
Address of assignee(number and street,city,state,and ZIP code) �,C(//�``��
Does applicant own property in any If yes,what county? What Taring District? Has this dedya.-•pr. 0.(egy;'.jlepNi AU tate DITOR amount of deduction
other county on property fk?IOL.g1�11VV 44LL 1VJIJU
in Indiana? ❑Yes E'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 C I 20 20 20 20
Signature of Cou 'Audi , V �, .../se SC
•-'V 1 Date(month,d ay.year)
l it.
I/We certify under the penally of perjury that the above and`I)Tegoilg infonna6on is We and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned pro ernon date application is filed.
`
/ sgnatu�(o:yneme /) ��,, /[/�" Date( on• day,year)
(Gl�� sttan—ands ,/ ''�/ "'a,' "`1'GL 4///�/
Full resident address of applicant(number and street City,stare,andn
ZIP code)
Dq pl
l a / '1 0 S 1-cd.t ROA t i0sk . 1-1-7le U r5
Person authorized by duly executed Power of Attorney or oy IC 6-1.1-12-0.7 Date(month,day,year;
Address of authorized person (number and street.Dry stare,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 310.000.