HomeMy WebLinkAboutMortgage_Whitler STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
f'- % FOR DEDUCTION FROM ASSESSED VALUATION S '
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t" State Form 43709(R12/6-14) •
���=' Prescribed by Department of Local Government Finance -F1 -t
INSTRUCTIONS: File Mark
To be filed in person or by mail. JUL F4nfj(tflyvith:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. �.r
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 • 71 • -ecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor ofMJ((�cc,p u " 8W16,7716
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where the property is located during the twelve(12)months before March 31 of each year the deduc`rNhir3 •bi-0 ` ' AUDITOR
See reverse side for additional instructions and qualifications.
Appli.= er o .. tract buyer-see bictigns on re a side,) / • /
axin• ' ct Key number a des`c�djtion Record number Page number
ortgage/Contract indebtedness unpaid as of Mortgage/Contrac ebtedness unpaid as of Is the applicant the sole
March .current -- March 1,current year date appigatio legal or equitable owner?/O`/ (9 ❑ Yes ❑ No
If no,what is his f 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 property in question:Annually Assessed
Real Property ❑ Annually Accecsed
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)
Name of assignee or other owner or holder of mortgage
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Address of assignee(number and street,city,state,and ZIP e)
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
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 n}Frrnithnt is the basis for The deduction.
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Deduction approved in the amount of
20 20 20 U.)'�^-A1I1L'T `c, 20 20
Signature of County Auditor r \ \6 Lion. U U Date(month,day,year)
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I I We certify under the penalty of perjury that the ...._...........—uua wnect and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signatu owner' ❑njJ . Date(month,day,year)
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erson 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 510,000.