HomeMy WebLinkAboutMortgage_Halbig (3) sr. STATEMENT OF MORTGAGE OR CONTRACT INUEB tEDNESS County Township Year
`1-'4 h FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R13/10-15) 40c1\
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, Q1APrescribed by Department of Local Govemment Fine ce I
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INSTRUCTIONS: SAC pvSVo��1(✓ . 4i`t, • 0 26_a 6-�j0 — File Mark
To be filed in person or by mail. ` 1� Q0 .19-\—fop Form filed with:
Filing Dates: 1) Real Properly:Must be completed and dated in the calendar year for which th educ�n rs 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/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.
licant(owner or contract er- e strictions on reverse side C
tin • n '
Toxin D st Key nu er/legal d c►i n Record number Page number
26 - .1- 0 b .20 0 -0 I . 633-—no kC . - O 1-012S
Assessed value of real property as of Mortgage i Contract indebtedness unpaid as of Mo ge/Contract indebted unpaid as of is the applicant the sole
assessment date,current year assessment date,current year date f apglisa�i legal o e stable owner?
�6 (`/�(`/1 Yes ❑ No
If no,what is his/her exact share of interest? If owned wi someone othe,than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: 1 property in question:Annually Assessed
ti1rG Real Property ElAnnua ssed
HAL_ 0�3-A IY1 Auoi Mobile Home(IC 6-1.1-7)
Name of mo ee or contract er
`� . + 1<i4Ta-y m) /ALcow
Address of mortgagee or contract seller(number anFILED
Name of assignee or other owner or holder of mortg; tia�0M ty� J� �� Er
O C T 2 '+ 2019
`�1 3(05a3o ao�-Liz
Address of assignee(number and street,city,state,I _ --�
Does applicant own property in any If yes,what county? What Taxing District? Has this d: t$ Y 'if�e�s,lstat�eamount of deduction
other county on property r
in Indiana? ❑Yes 0 No 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 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 0 20 20 20 ' 20` 20
Signature of County Aug/(:orIrv+ c J Y County Date((month, ar)
I/We certify under a penalty of perjury that the above and foregoing information is true and correct andi that the applicant is a resit t of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sig ature(owner's full name) r Date(mom ea 1 pt
r� o l f
Fullresident address of lira number and ate,and ZIP code)
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1 � � et
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Person a horized by duly executed Power If Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized 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.
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