HomeMy WebLinkAboutMortgage_Anderson (5) �.n. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
`v ,12 FOR DEDUCTION FROM ASSESSED VALUATION
l State Form 43709(R12/6-14) r_ -
Prescribed by Department of Local Government Finance r -,p
INSTRUCTIONS:
To be filed in person or by mail. Form led with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. a,n • FFFF����1111
Must be tiled or postmarked with the County Auditor or County Recorder of the county where the propapk is1 5 2 11 County Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of th- ..unty
where the property is located during the twelve(12)months before March 31 of each year the deducti.,I.. u..! _-—
See rave -de for additional instructions and qualifications. ' frit
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APP ra g/ e. n•• - L-cr�reversy/ s
Ci G- kerf Ask et .
T- Key •m•e I gal desai lion Record number Page umber
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value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March 1,current year date of application legal or equitable owner?
dc96. ❑ 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 ,�JSg
Address of mortgagee or contract seller(number and street,city,state,and4IP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does a (.( xing District? Has this deduction been requested If yes,state amount of deduction
other c `^i`�Jl/ — on property
ea?for
in Indu current year? ❑Yes ❑No
A pers ance on the person's mortgage or contract indebtedness that is recorded in the county
recom /5'a (�Q,9 [Died in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR .
Dedu
20 20 20 20
Signature or w,....,.._ 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.
Signature e/s n Date(month,day,year)
•
Full dent address o app iwnt(num and street,city,state,and ZIP code)
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 510,000.