HomeMy WebLinkAboutMortgage_Loesch (2) 0o. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship Year
- �� ; FOR DEDUCTION FROM ASSESSED VALUATION
`-:, f = State Forth 43709(R13110-15)
1e,.; Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail. Form filed with: s
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 ❑ 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 Counfy 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 restrictions on reverse side)
.37eY V%c ems' N . !-0 eS ekN d- CSr1ei5c,Q. - 1_o eSCi--N- -
Taxin District Key number/legal description Record number Page number
t N �lQ-OUz.-Q1- In0- boo• 34 -CC1 2O\9 . Cigr2q
Assessed value of real rty as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year d e of application CV legal or equitable owner?
nI , ❑ Yes ❑ No
If no.what is his 1 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 operty in , -stion:Annually Assessed
eaI-..,s. L:1 AnnuallyAssessed
• _•• Mobile Home(IC 6-1.1-7)
Name of o gee or tract set , .
0 a a =► Or, � c .l� ,
i
Address of mortgagee or contract seller(number and street city,state,and ZIP code) spy �r�\°
`� ,.�
Name of assignee or other owner or holder of mortgage at R
1 ll? Q\�O
. All Av
Address of assignee(number and street city,state,and ZIP code) \\ &) � 1�
OA
Does applicant own property in any. If yes,what county? What Taxing District? Has this deduction been r `eedd CIyes,state amount of deduction
other county / on property for
in Indiana? ❑Yes L rNo current year? es ❑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 20 20 20 20 ' 20' 20
Si re of County Auditor C unty Date month,day,year)
. D-t b. k t--c3 Lc--( Q
I/We certify under the penalty of perjury at the a e and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buy= of the aforementioned property on date application is filed.
Sign>t e(owner's full na 1-) Date month,day,year)
I Al a, 6
®es.ent a dress. ..scan nd street te,and ZI e)
Person authorized by duly executed Power of Attorney or by IC 1 •
11.1-12-0.7 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.