HomeMy WebLinkAboutMortgage_Smith (36) r. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County o i Year
FOR DEDUCTION FROM ASSESSED VALUATION IL 1r
S• State Form 43709(R 12/6-14)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: AV -rk r
To be filed in person or by mail. Fn . 'iq.
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought ❑
Must be tiled or postmarked with the County Auditor or County Recorder of the county where the property is •u Audi •
located on or before January 5 of the immediately succeeding calendar year.
�]1�1 ' s ifMT !. Recorder
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County year t Auditor of ioMt di flu'
where the property is located during the twelve(12)months before March 31 of each year the deduct' 9S3d7 C, - -
See reverse side for additional instructions and qualifications.
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Taxi gstri1c/tl,/ ,mulct Key rw'�mb{,eY/r_l legal description R number I Page number V in�e A,-la -6(p-L{ol -ooa. 3g3 -o as �1�ei' wK td'to fit Colt Iy -35'5
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1 year March 1,current year date of applica' legal or equitable owner?
�� 1 &)O s ❑ No
If no,what is his/her exact share of interest? If awned with someone other than spouse,indicate with whom
If name on record is different than that of applicant.indicate below: Is the property in question:Annually Assessed
1r-Fleal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
-
Na mortgagee or contract sell
errncw, icc r, '&. ncorp
•
Address l Inortgagn:egrconUyctseAerinumbwgWStree state,end ZIP code) 416
Name of assignee Of other/roownneerr or holder of`dmortgage L/•'l•��+`p•,r'^ r(/
Address of assignee(number and street,crty.state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes 0 current year? ❑Yes ❑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 I 20 I 20 20 20 20 20
Signature of County Auditor I County I Date(month,day.year)
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date applica•w/,- filed./�//f,//�
iqri(o/Jw/n/�(�'s��hall name) x y � '" _ a Date((monyn day.X .U-//l � Gl��//nt addre of applica (nunits.a snot.ag[`srate,aI(d r code) I �1�1- , /17 b 70
Person aauuthorized by duly executed Power of Attorney oorrbbyyIIC 6-1.1-12-0.7 rice-- eV,,v-•' �`J T I 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.