HomeMy WebLinkAboutMortgage_Collins /a=�;,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year I
1 a . .\ FOR DEDUCTION FROM ASSESSED VALUATION
4tiii�,, State Form 43709(R12/6-14)
. Prescribed by Department of Local Government Finance �1�-_.( PD
INSTRUCTIONS: t-File MaCfk c
To be filed in person or by mail. r EB1 ItslE4y)N:
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. Recorder
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor of pqt�
where the property is located during the twelve(12)months before March 31 of each year the deduc(T. O11H7 ' UD(TOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
CHRISTOPHER R. COLLINS AND KENDRA N. COLLINS
TaxiAstrict Key number!legal description i Record number Page number
_ � I ab-19-t�1-�o. cot. aq) -oad , 4fckL A.t(ills i i 15 -1de
Assessed value of real property as of 'Mortgage/Contract indebtedness unpaid as c Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mai' ulrenty rroo March 1.current year date of al S o I legal or equitable C N
."!7— IWnt '4 ��/ X Yes ❑ No
1 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 t oroperty in question:Annually Assessed
i eal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
!lame of mortgagee or correct II=-• II __
I\/I��'yLAI d��i
Add ress ofmonoagee or contr seller(number and str- Y.state ad 7rlPcode) --}- - r ' ^�
I & NiUJ �u'� lQ ! t51.1�-2 I`n1V1 '( !
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state.and ZIP code)
Does applicant arm property in apt If yes,what county? 1 What Taxing District? Has this deduction been requested If yes.state amount of deduction
other county , property for
in Indiana? Yes bOo 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.
I COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 I 20 20 20 20
Signature of County Auditor County 1 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 application is filed.
4 tatur hid name - Date(month.day year)
Fm resident . o applicant(number and street,city,state,and ZIP
Person authorized by duty 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 S10,000.