HomeMy WebLinkAboutMortgage_Wagener 4. 4 , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ' County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
;�` State Fonn 43709(R13110-15) J� ��
N,S. 41 206
.e s
fy , Prescribed by Department of Local Government Finance
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 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 i ctions and qualifications.
Ap ``nnt(own or (�tract buyer- restrbb.ns on reverse sid 1p A
T l igistnct „A jurnberIleg=r' °a
ti i2-ll , Record number Pag number
.SO -23 o ee r 4 , -: z . 29kR kilS 6 0
Assessed value of real property as of Mortgage/Contract indebted' u ai as of 5 1-• I ontra ebtednass unpaid as of Is the appli.-nt the sole
assessment date,current year assessment date,current yea'. 1 da ,+, -�a Ica'on legal o e.,.dable owner?
�� I Yes 0 No
If no,what is his I her exact share of interest? If own A a. eOne1oth9(than spouse,indicate with whom
NOV 1
If name on record is different than that of applicant,indicate below: I e property in question:Annually Assessed
Real Property ❑ AnnuallyAssessed
' '" Mobile Home(IC 6-1.1-7)
Name of m ge rco IIIV‘tk ..\,4
Cy kin 1�1{3$ON CGII '
o Address of rtgagee or con seller(number and street city,state,and ZIP code) •
Name of assignee or other owner or holder of mortgage ��.�:�,,,..
Drawer
Address of assignee(number and street,city,state,and ZIP code) T
14'.
Card NO. ........ . . ..
Does applicant own property in any If yes,what county? Wha, _ _ • - - " :ed If yes,state amount of deduction
other county
in Indiana? ❑Yes ❑No No
A person is not entitled to this deduction unless the person has a b, edness that is recorded in the county
recorder's office(including any home equity line of credit that is rec is for the deduction.
__....r r iauutIOR
Deduction approved in the amount of:
20 ' t0 20 20 - 20 ' 20• 20
Signature of County Au•11! Coun Date on day,
�0� \� l •
I/We certify under the penalty of perjury tha ove and foregoing information is true and correct and that the applicant is a resid nt of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Sig lure wn 's full name) 4 A ' Date{m'nIi
,di\,}r� j `
1 J, Ill
...dtjecari—oi
ull resent address of ap licant(number d street " ,state,and ZI
Person authorized by duly executed Power of 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 periury can include imprisonment uv to two and a half years and a fine not to exceed S10.000.