HomeMy WebLinkAboutMortgage_Layman .v STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
- { FOR DEDUCTION FROM ASSESSED VALUATION
\'-$` State Form 43709(R12/6-14)
sale Prescribed by Department of Local Government Finance _ -
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INSTRUCTIONS: , , ��;
To be Red in person or by mail. • - °.'.r T'-:with:
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 prop i? 9 p r County Auditor
located on or before January 5 of the immediately succeeding calendar year. Lr J County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction i-JJ:.ugllt. t .,ow--
See reverse side for additional instructions and qualifications. Il grnlj',
Ap lirant(owner or contract buyer-see restrictions on reverse sid ) BSON COUNTY AUDITOR
Taxing Distd Key numb /legal description Record number Page number
gt d.-c� a ‘ - mi8400-001 -no? -o ; 6 aO/5 d /36
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 March 1,current year date of application legal or equitable owner?
.2f0,000 ❑ Yes ❑ No
If no,what is his/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 the properly in question:Annually Assessed
El Real Property ❑ Annually Assessed
,� _ /\) Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller • xe ct�✓Y
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? r What Taxing Dis Dra Wet- r _°SO/ to amount of deduction
other county ❑Yes ❑NO )�O...,....,.., ..
in Indiana?
A person is not entitled to this deduction unless the person has a balance c s recorded in the county
recorder's office(including any home equity line of credit that is recorded it Card Np1O'�r 0,00 duction.
COl C LCpiO' 't �. '�.. ........
Deduction approved in the amount of: q`ll.p41-317)940 20 20 20 20 20 20 20
Signature of County Auditor County 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. ,
Signature • efs full name) ,, Date(month,day,year)
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Full resident address of 3 plicant and street,city,state,an ZIP code) }7
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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$10,000.