HomeMy WebLinkAboutMortgage_Mason (2) tSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
z State Form 43709(R12/6-14)
Prescribed by Department of Local Government Finance
INSTRUCTIONS:
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To be filed in person or by mail. Form tiled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. APR `r1 ?�pp,j�S
Must be(led or postmarked with the County Auditor or County Recorder of the county where the property is y��County 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 44. t • i .
where the property is located during the twelve(12)months before March 31 of each year the de ctign i. .:;• .,i'''n;
See reverse side for additional instructions and qualifications. B ON COUNTYAUniTOR
Appli - y(/ ner or co tract buy,r ysee - ns qn rev side) I / ��
F IB / _ace ac) /�./
Taxint • .trid number/ I•-ip0on y / Record number Page beer
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-•va f real p•••-rty a.of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Ma % 1,con-ear March 1,current year date of application legal or equitable owner?
❑ Yes ❑ No
If no,what is his/her exa• , are of interest? If owned with someone other than tpouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is t property in question:Annually Assessed
Real Property ❑ Annually Assessed
/ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /
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Address of mortgagee or contract seller(number and street,city,s ate,and-C1-)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) /q[[[[[[//////������//// Z7�� 1
Does applicant own property in any If yes,what county? What Taxing District? Has this✓deedllcJon been requested If yes,state amount of deduction
other county on properly�{1p/
in Indiana? ❑Yes ❑No current yea . ❑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 equitvline.nfrrcr+a.0- - -- aunty recorder's office)that is the basis for the deduction.
UDITOR
Deduction approved in tl -
20 NO ap 1•,.•T..•
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Signature of County Audit /9, J ounty Date(month,day,year)
Card NO. ... ... • . ---///
I/We certify under t.. on is true and correct and that the applicant is a resident of Indiana and
owner/contract buy. - .. cppncatton is filed.
are(owne full name) Date(month,day,year)
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} F N address of applicant(num•er an•street cit,slate,and ZIP code)
1 5� W, 5-95 S - o Svi(Ie 1v) IA 7 (Q(e5
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 S10,000.