HomeMy WebLinkAboutMortgage_Heldt (13) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
.-1;;.-. 12, State Form 43709(R13/10-15)
�-- Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To 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 properly is ❑ County Auditor
located on or before January 5 of the immediately 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 Ss on reverse side)
Tarr and .\e cc4 -- ,
T - g District Key number/legal description Record number Page number
0n._0_?.,� e� -oto - �o- - 000 . L-o rR 2O 1' 3sb
Assessed value of real 7rty as ail Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date, �r assessment date,curterd year Battle,of application Sb legal or equitable owes?4 ore
( Doff — s ❑ No
If no,what is his/her exact share of interest? If owned with someone ogler than spouse,indicate with whom
If nacre on record is different than that of applicant,indicate below is the in question:Annually Assessed
eal Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or Contract seller
1
GO 4--,mot- )v 11e �e a. C' 49 _ 1 yr ':. .
Address of mortgagee or contract seller(number and street coy,state,and ZIP code)
Name of assignee or other owner or holder of mortgage V ` o. ��Q�9
Address of assignee(numberand street,city state,and ZIP code) %`� ,l /
f P�O1�pP
Does applicant own properly in a If yes,what county? What Taxing District? Has this deduction been requ a amount of deduction
othein lnthanacou7?ty ❑Yes No curr on ent yeea?rLY for ❑Yes rr�-� G
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract inee�ness 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
Sig re of County Auditor Dort (month,day,year)
� � I J e tb� u.—�-- `.
I/We certify under the penalty of peiju that above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of th a orementioned t roperty on date application is filed. • - -
Signature( e) ostcrowoar,day,year)
uli r n address of p (n• .-r-•.street,city,state,and ZIP code) ''��
Si • L\or, fJ �r0. - C4sC'n ,.�I" ,
on authonzed by duly executed P.- -r of Aitomey\Dr by IC 6-1.1-12-0.7 1 Date(month,day,year)
Address of authorized person (nu be,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.