HomeMy WebLinkAboutMortgage_Ryser .M 1". STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
d` ' -.s FOR DEDUCTION FROM ASSESSED VALUATION
-`-•V`a hfyf!
State Form 43709(R13!10-15)
Feu
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by malt Form 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 El 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.
Appli nt(owner or o tract buyer- ee strictions on reverse side)
mt. Q..,
Taxing strict A Key number/legal description Record number Page number
q 24 - /-01-/DO- 0oj, 9: y o02-7
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?
vero`5 COO s ❑ 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 rty in question:Annually Assessed
eal Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract
seller
/ 6 / '�� -
/- rdi.�rret., /✓��� �N .
Address of mortgagee or contract seller(number and street city,state,and ZIP code)F /��\
/LE 1„
Name of assignee or other owner or holder of mortgage T 1
DI"a11'L'I' �7 O
Address of assignee(number and street,city,state,and ZiP code) N 0 V 14 2019
c\s(--\
Card NO.
Does applicant own property in any If yes,what county? What Taxing District? as is deduc
other county ' , property forh '� TY AUDITOR
in Indiana? ❑Yes ❑No rren ear? f�rja A person is not entitled to this deduction unless the person has {i. 1 f: AO atOlte or con ct indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that ���`co' fed inihe 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
Sign o County Auditorr, County Date(month,day year)
skh4
I I e certify under the penalty of perjury that the abovnd foregoing information is true and correct and that the applicant is a resident of Indiana and
n:_ ..ntract buyer of the aforementioned property o date application is filed.
Sic --_ ,am Date(month,day,year)
Fu e2ide`ntad dress o'/f�`a�/pp�r t��(number and t,city,sia'te'and/Z/Pcode) /� � � / � ��
Person authorized ze by duly executed Power of Attorney by IC-1.1-12.0.7 �J w, Date(month,CJ day,year)
//-/'74-/ 9
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.