HomeMy WebLinkAboutMortgage_Kahle (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun q, nsh' ear
.1 FOR DEDUCTION FROM ASSESSED VALUATION
r State Form 43709(R12/6-14) -
Prescribed by Department of Local Government Finance
INSTRUCTIONS: FRN&'1 2015
To be filed in person or by mail. Form fled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be f i l e d or postmarked w i t h the County Auditor or County Recorder of the county where the property i s I • A 04? '••.d•r
located on or before January 5 of the immediately succeeding calendar year. / 'S' '?!". Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of theGIBSO N C I TY A DI e ;
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.
Appliwn (ewnerorcgntractb err sere son reverse )
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Ot ist vi net in Key moe—r 2g—al dis8thion 403_002. 6 2 q-0, wits. Pag 51
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Assessed value of real property aLti Mortgage/Contract indebtedness unpaid as of Mortg ge/Con ct indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date ap ¢a /y 2 CO egal or.CeJJglh3Ge owner?
� I n 1 1sp "se p l/(/ Yes ❑ No
If no,what is his/her exact snare of interest? If wined with eone o err bfa spouse,indicate with whom
If name on record is dCferent than that of applicant,indicate below: Is the roperty in question:Annually Assessed
eaI Property ❑ Annually Assessed
�(e ytp JIQ� ,I(� oaf J 1��af ,�o� Mobile Home(IC 6-1.1-7)
NV fo p°rvl ts/ rnurt c�`V�ci v �I✓ 1) �0nsvil For
I ��15
+��Y/ , on
ka me of assignee or other owner or holder of mortgage
Address of assignee(number and street,dry,sate,and ZIP code)
Does applicant own property in y If yes,what county? Vrhat Taxing District? Has this deduction been requested If yes,state amount of deduction
other county , property for
in Indiana? Yes No 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 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
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 •roperty on date application is filed.
Si.• n-iu utl ame) / ` Date(month.da .year)• J J nr'c,�m4hq pp K 1.11, 3 2 -
1 UeirarVl��,/�nJ\flmbe'r a..'{�/5`t'�)relye/1rr. r1e a^dZ a) l/ V C07V
erson authorized by duly exeth er of.ffiwney or,bby IC 6P1.1-12-0.7 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.