HomeMy WebLinkAboutMortgage_Higgins (2) ^•>•a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS i��MISME 1C'rip Year
°a6 = FOR DEDUCTION FROM ASSESSED VALUATION a
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State Form 43709(R12 I6-14)• Prescribed by Department of Local Government Finance S[IP 1 2014
File Mark
INSTRUCTIONS:
To be filed in person or by mail. Femrfiled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is so LµL-IJ,111------111
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Must be filed or postmarked with the County Auditor or County Recorder of the county t�dte Y Al. ]OCounty 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.
Applicant(owner or contract buyer-see restrictions on reverse side)
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Taxi Di' I Key number/legal description rr l�SW IL 4_)I Reco�ry�hq����/I Pa
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of a pli tan legal or equitable owner?
2sj900, 00 .00 1 4L-tI SDO -a0 ❑ Yes ID 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 property in question:Annually Assessed
❑ Real Property ❑ Mobile n Annu
ally ss 61.1-7)
Name of mortgagee or contract seller
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Address of mortgagee or contract seller(number and street,city state,and ZIP code)
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Name of assignee or other owner or holder of mortgage
Address of assignee(number and sweet.city,sate,and ZIP code)
Does applicant own property in an If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county , property for
in Indiana? Yes o 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 20 1 20 20 20 20 20
Signatur of County Auditor , County Date(month,day,year)
I/We certify under the pe alty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/ •ntract buyer of the . orementioned property on date application is filed.
Signet re • ner's full it e) Date(month,day,year)
Full re,fent addres 14 appf . t u Per and street.city,state.and ZIP code)
115 7 8 / so 47 /c/CL afra zi -Ct-t- ecn Y 7 (v 3 2
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.