HomeMy WebLinkAboutMortgage_Koch (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
., ,k :r FOR DEDUCTION FROM ASSESSED VALUATION �7.�,�
--; State Form 43709(R13/10-15) . J[,9
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. F 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 instructions and qualifications.
Applicar(t.(Kner
�orr contract buyer_ see restrictions on reverse side)
T - Distri ` �'/`l�„IKey`'number/legal description R rd mbar Page number
26-ZO"` 2-S--190 �ooO. CN -001 �S MYS
Ass sad 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 lir)T4 _0 legal• e•. rbleowner?
l:1 Yes CI No
If no,what is his/her exact share of interest? If owned with so e0ne er that/spouse,indicate with whom
if name on record is different than that of applicant,indicate below: 1 property in question:Annually Assessed
Real Property ❑ Annually Assessed
' Mobile Home(IC 6-1.1-7)
Name rtgagee ►, tractl}0r
1.A.Di'iiItt
'Address o mortga• ntract seder(rumba n s t city,state,and ZIP code) FILED
Name of assignee or other owner or holder of mortgage
��{f� MAR 9 2020
Address of assignee(number and street,city,state,and 2 D i�a 1Y e 1- NO. Y ti'••
l
Does applicant own property in any If yes,what county T q,S7S-- spthis deducti•fr) ��! -�r){�� If yes,state amount of deduction
other coun ro forin Indiana? ❑Yes ❑No Card NO• r�n r0EitYOU TVINAI,DITOR
A person is not entitled to this deduction unless the _ ortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of( • der's office)that is the basis for the deduction.
Deduction approved in the amount of
•
20 20 20 20 20 ' 20' 20
Signature of County Audi ` 1 County t3ovi Date( y,7
b2.„
I,We certify under the penalty of perjury tha above and foregoing information is tr nd correct and that the applicant is resi ent of Indiana and
owner!contract buyer of the Xaforementi ed property on date application is filed.
Signs�, a(owner's f Il name) Date nl5rr;1a a�
tF'resid. a..ressofa�icant(number and et city,state,an ZIP de
Sil is SA2 5 , t0
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 perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.