HomeMy WebLinkAboutMortgage_Meny �°•nq STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.4-�-_/,, FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14)
' tele 1 Prescribed by Department of Local Government Finance
INSTRUCTIONS: 1gJ
To be filed in person or by mail. F w:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. JUN i {f i 1:J
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is - LLI County Auditor
located on or before January 5 of the immediately succeeding calendar year. .- .. --corder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the cou ' • „�i
where the property is located during the twelve(12)months before March 31 of each year the deduc' 2 - '-
Seereversesideforadditionalinstructionsandqua lifications. 8 ' OUNTY AUDITOR
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APp/ lJ ) ) ' /
T 'strict number/I al description Record number Page number
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Assessed valued real propery as of age/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpa' s of Is the applicant the sole Marc'1,current year h 1,current year date of application // n /0 legal or equitable owner?
O�z T/�'/ ❑ 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: its tpe property in question:Annually Assessed
III/I�,LY,J Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller J/ ,r at ^
Address of mortgagee or contract seller(number and st/city,state,an 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? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county- on property for
inlndiaaa?__ ❑Yes ❑No current year? ❑Yes ❑No '
A per "--'- iha nerson has a balance on the persons mortgage or contract indebtedness that is recorded in the county
recor L-. ( — s 1 is recorded in the county recorder's of ice)that is the basis for the deduction.
l J COUNTY AUDITOR
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. 2-,A-„\ .,�K. - 20 20 20 20
Sig ^� "•'- County Dare(month,day,year)
vJ "`t-- -A 1 , 6 (100_ 0 U and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract wyo� ,,, ...__._-. ' _ -n date application is filed.
Sign (own full name) 1 Date(month,day,year)
Full resident a applicant umber an et,catty,s s t to nil 7J 97(3y x / / A/ 4/e' Si 4, - .
Person authorized by duly 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 S10,000.