HomeMy WebLinkAboutMortgage_Wolf �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES
ty Township Year
' ''�° FOR DEDUCTION FROM ASSESSED VALUATION
ci `h
`;,.. ,fa,„
State Form 43709(R13110-15)
#° ' ` Prescribed by Department of Local Government Finance
INSTRUCTIONS: 0 C T 4 2019File 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 prope d 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 Code el((a" q I'p l OR
•
. / CSC/ i -el--
Taxing District Keay number//legal description-I
/�� 4 Record number Page number
O�Co . / Y -o7 -- DI , ODD • b ( { -DA � AVt9 l ,Za.5
Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
5O00 ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
/If name on record is different thanthat of applicant,indicate below: 1 the o
PP periy inquestion:Annually Assessed
[real Property 0 Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ,(' , '
Address of mortgagee or contract seller(number and sttreel;city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage (2) n
Drawer NO........ '�11
Address of assignee(number and street,city state,and ZIP code) I ' 2•
Does applicant own property in any If yes,what county? What Taxing District? Has this di Card NO• ••••• ` iJ S ,
other county on properfi ............
in Indiana? ❑Yes ❑No current yet. . •
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 20 • 20 ' 204 • 20
Signet re of Countyior County Date(month,day,year)
/
1 l We certify under the penalty of perjury that the above n/ oing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day,year) •
ull residen t d of c pplicant(number and street,city,state,and ZIP code) .-----
Person authorized by duly executed Power of Attorney or idriG Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
Thy.nanaitiae fnr narkint ran in,Uvie imnriennmanf,in to i,,,n and a half vaarc anti a firm ant to avt aarl 0111 Mr1