HomeMy WebLinkAboutMortgage_Reed (2) t.v STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count j wnship Year
0 z FOR DEDUCTION)FROM ASSESSED VALUATION g � M
' '' State Form 43709 R12/6-14 I 7
��‘-zi Prescribed by Department of Local Government Finance
INSTRUCTIONS: JUN Zu J Mark
To be filed in person or by mall. JUN ' Form filed 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 .p .erty is -t- County Auditor
located on or before January 5 of the immediately succeeding calendar year. YJ r• 4 ' p' ❑ unit'Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County he 3•-. • Y AUDITOW
where the property is located during the twelve(12)months before March 31 of each year. ion is sought.
See reverse side for additional instructions and qualifications.
Appli (owner or contract cs resin rye side
Taxi istric( Key number/legal description Record number Page number
/1.4_70--tarerr--2 2(v - J ), -o6' - lot[ — cox. eoa _ 0 x. e is a.z8/
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?/ 3 /q on ❑ 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
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) S
Name of assignee or other owner or holder of mortgage
—
Address of assignee(number and street,city,state,and ZIP code) is- d>z 8/
—
Does applicant own property in any If yes,what county? What Taxing District? Has this dedur
other county on properly for
in Indiana? ❑Yes ❑No current year? U Yes U No I
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 �1.� ,( 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
/My' " " _
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.
\ ' nature owner's full na Date(month,day,year)
0n r,�_ I
Full resident address of appli (nu ber and s 1, rty,state -•dZlP code 1---1\) 0 LP-)
Person authoriz-•by du ex,.0 ed 'owe/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 S 10,000.