HomeMy WebLinkAboutMortgage_Przymus (2) e 4 i STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a_ = FOR DEDUCTION FROM ASSESSED VALUATI(�N� /LE
t, �i,/ State Form 43709(R12/6-14) yg-1
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. JUN 9 205 Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sou ht.
Must be tiled or postmarked with the County Auditor or County Recorder o e coup a property is County Auditor
located on or before January 5 of the immediately succeeding calendar ydieu County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:M(rsl§I@1�1 h8( ygty tTOR county
where the property is located during the twelve(12)months before m 1 o each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant owner or con Tact buyerr_�see restrictions on reverse sid )
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Taxing 2"rict Key number/legal description Record number Page number
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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 unrent yrear, date of application legal or equitable owner?
7 WO ❑ 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 property in question:Annually Assessed
iczym Droperty El Annually Assessed
uS Pay, '—Mobile Home(IC 6-1.1-7)
Name of mortgagee or oonnttrrract seller C.
Address of mortgagor contract seller(number and street,city,state,and ZIP code) P L d&? L
Name of assignee or other owner or holder of mortgage /�a37D/
Address of assignee(number and street,city,state,and ZIP code) (v
Does applicant own property in any If yes.what county? What Taxing District? Has this deduction ue..... ,mount of deduction
other county on property for
in Indiana? ❑Yes III 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;co ract buyer of the aforementioned property on date application is filed.
Signature(dwwn s full name)f/[' Date(month,day,year)
K ��/��1a—G - r 4.1 6.- - 7 c- z-vif
Full resident address of appcant(nu and street,city,state,and ZIP code)
A is l 1 1o.;.z4 /1"1-4 r ST )1/ c5-7r x—/-> if 7d7O
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 510,000.