HomeMy WebLinkAboutMortgage_Carlson (2) .4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
"e%-f FOR DEDUCTION FROM ASSESSED VALUATION �—�r $e
State Form 43709(R12/614) F Y
\e i Prescribed by Department of Local Government Finance
INSTRUCTIONS: Fie ar
To be filed in person or by mail. APR 6 ded with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. ~r � LII
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
Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
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a � Inc s 'ey n be/rr I llegACaall ddees ption C��(�(J� /'/ /� Record number Page number
a. _(,277. 0/0/. OO a3. ,9la d" • 0o12 �/i0/�` /SS/
Assessed value of real property as of ortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year arch 1,current year date of applica.0O /.< 99
legal or equitable owner?
L`11 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than pouse.indicate with whom
If name on record is different than that of applicant,indicate below: Is t e property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller r`o� ` A
C .d stye ! U
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested._I.tf.ua'-----
other county on property.Lv
in Indiana? ❑Yes ❑No can
A person is not entitled to this deduction unless the person has a balance on the person's me ay
recorder's office(including any home equity line of credit that is recorded in the county recoro _/ 0 k 5-
COUNTY AUDITOR 1 c7�
Deduction approved in the amount of:
IS3,I.......O.20 20 20 20 C;1 r d
Signature of County Auditor County
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.
Signature(ow is full name) Date(month,day,year)
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Full re ' t ca and treet,city,state, P code)
/
P n authorized by duty executed Power of Attorney or by IC 61.1-12-0.7 (Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) ' , fl 1.
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.