HomeMy WebLinkAboutMortgage_Smith % STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14)
5 Prescribed by Department of Local Government Finance FIL
I
EP
NSTRUCTIONS: _
To be filed in person or by mail. 1 .,r T Hi ed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought.MAY 1.4 LU I J
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. 7 _ ty
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor oft• i y r s V rina n Recorder
where the property is located during the hvelve(12)months before March 31 of each year thud/fig �.f(f a• `u TY AUDITOR
See reverse side for additional instructions and qualifications.
C-ASPnt(owner or contract ry�pr-see restrictions on verse side)
riciffn ( 'CUQ f, Ea_r;flt_ tcO1e L . UlriitL,
Taxing District 1 Key number/legal descn n Record number Page number
!-Ini_Ab. \CW\1— :_� — iG 1-3Uf- 000 .l 1 -oog ao∎s - 1 RS
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 Mar rrentxX ear _ _ 03 date of application legal or equ'tie owner?
4Icy1 133 [Tj Yes 0 N
If no,what is his/her exact share of interest? I If owned with someone other than spouse,indicate with whom
''If name on record is dtterent than that of applliicant,indicate below: ry,,.� \ Is property in question:Annually Assessed
U M(n cf ( A/Ia \{-( Y/A n ( j \`.1 y..L; CIA\0) Real Property 0 MnnueVHom 6-I.1-7)
Motile Horne
Name of mon or act seller
So ! I o S in+e 'N Vet .)1 tIclrn�,-i tl9 r h-h`� ► .
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 courtly? Wnat Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on properly for
in Indiana? 0 Yes 0 N current year? ❑Yes 0 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
Signatu 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 property on date application is filed.
Signs ow f O name) Date day,yea
x � '► I
Full resident a ss �nt(number and street,dry,state, nd ZIP code)
,s� IA N CLr e.S •'r\1 k -\G c NI � (Q C\
Person authorized by duty executed Power of Attorn)?or by IC 6-1.1-12-0.7 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.