HomeMy WebLinkAboutMortgage_Greubel (7) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
i FOR DEDUCTION FROM ASSESSED VALUATION
~,. '^ State Form 43702(R13I 10.75) fa y/\ ( O `, 'd ` C Q
Presatbed by Department of Local Government Finance JJ VJ r 1V_ ` c�+�1
INSTRUCTIONS: _ File Mark
To be filed in person or by maiL F filed with:
Filing Dates' 1) Real Properly.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/ManufuOured Homes not assessed as Real Property:Must file with The County Auditor of the county
wham 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 rn a/ see on reverse side)
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Assessed value of real p.vpn,ty as of Mortgage/Contract indebtedness unpaid as of M I Contract indebtedness unpaid as of Is the ap icant the sole
assessment date,current year assessment date,aurent year date Saban 1� legal or Cable owner?
XO Ci O V r . Yes ❑ No
If no,what is his I her exact share of interest? If owned with eone other ttyh spouse,indicate with whom
If name on record is different than that of appGrarn,indicate below. a property in question:Annually Assessed
Real Property 0 AnnuafyAssessed
• Mobile Home(IC 8-1.1-7)
Name of mortgagee or contract se
e _ jE
Address of mortgagee or contact seller number and street ay,state,and ZIP code) .
Name of assignee or other owner or horde----- JUL 17 2019
Address of assignee(number and street,, D A v.Cp 3
nIRSON COUNTY AIIRITQR
Does applicant own property in any If y 62E NI O A L- :this deduction been requested If yes,state amount of deduction
in Indiana? ❑Yes ❑No n ' I enter? r7 voperty for ❑Yes ❑No
A person is not entitled to this deduct / (- Li 3(i'1 ;Midge or contract indebtedness that is recorded in the county
recorder's office(including any home ier's office)that is the basis for the deduction.
Deduction approved in the amount of:
•
20 0 20 20 • 20 20' 20
Signature of County dito -FYI County - Date(month, y,ye
"I tal
I IWe certify unde e penalty of perjury that the above and foregoing information is true and coned and that the applicant iss a iiden of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signature Date(month(day,ye
3QZSe us name) lb2S-3 - 3h_y --63c1. 9' I.7' t� r
i
Fug rent address of applicant(number and street state,and ZIP code)
.019 -G I . d�/J.
Person authoriz duty executed P of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of autimized 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.