HomeMy WebLinkAboutMortgage_Collins II .air= STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
IS.?
State Form 43709(R12/6-14) pg
Prescribed by Department of Local Government Finance � q
INSTRUCTIONS: File Mark
To be filed in person or by mail.
1J 15
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 property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. I O.C.,n
2) Mobile/Manufactured Homes not assessed as Real Properly Must file with the County Auditor of the county / Jr •
where the property is located du twelve ring the elve(12)months before March 31 of each year the deduction is '1 "-"��
See reverse side for additional instructions and qualifications. attigON COUNTY TY AUDITOR
UDITOR
Appl nt(own r or contract buyer-s restrictionsr on reverse side , (
I Ii nliS - f v) r' �! a4<10t_ V cc milt Coiii/�
T n tdct / Key number/I a description✓ Record number Page number
ak-ki 4' - ia- I T,-u03-0c�a. 61-4�-0ab' aol a360
Assessed valued real property as of Mortgage/Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of I Is the applicant the sole
March 1,cement year MarlUra�,arrent yreca: 1 U f (1 date of application legal or,, rrta' de owner?
`-'1 �-✓ �-Y� V vV _ L'I Yes ❑ No
If no,what is his/her exact share of interest? r If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is a property in question:Annually Assessed
[VJ Real Property ❑ Annually Assessed
-�Name pl portgagee?eeer contract seller ��� O � �J Mobile Home(IC 6-1.1-7)
Address of i rtgaggp�. a Iler(number and et,dty,state, e _
G=\3- q-)01 (1 Q Va , lamlri I( D ‘IX ! 41113
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 If yes,state amount of deduction
other county ,--, properly for
in Indiana? Yes ❑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/contract buyer of the aforementioned property on date application is filed.
Signat 1 e/s 1u a e) ^ / ,r
f`4 t/(/� ee.A'_ Date(month,yay„yga1 /
Full ��Vddr p(ap/ ,/ntmbeq�ntls.//,))eel,city atintl ZIP
�r, ) ! 1 ,��� 0
Pe authorized by duly executed Poveruof ATforney o by IC 6-1.1-12-0.7 / V1'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.