HomeMy WebLinkAboutMortgage_Almond STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION ,Il
: t; State Form 43709(R12/614) �I talE Prescribed by Department of Local Government Finance INSTRUCTIONS:
To be filed in person or by mail. JUL 11 f�A yp.�+
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. - U u L U I7
- Must be filed or postmarked with the CountyAuditor or County Recorder of the county where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. .5 _•2).,Mobile/Manufactured Homes not assessed as Real Property.Must file with the County Auditor of the'cou .5 r��•nilCunt • •rder
.•where the property is located during the twelve(12)months before March 31 of each year the deduc5Q.: ,rt - '-'
See reverse side for additional instructions and qualifications. OUNTY AUDITOR
App6pb (owner or contact buye - - -sbictions oreverse side)
t�J/ I III
I Key number I al description R number Page number
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•,value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March i,current year Marcp rrrennt year/1 date of application legal or�erquitable owner?
I LI�V • 0 1 i - 00 Id1 Yes ❑ No
It oo,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: 7°I,s�the property in question:Annually Assessed
1) l Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Namerrtgagee or contract seller
� cd .e Lip) \aid
Address of mortgagee or co ct seller(number and street,a ,state,and ZIP code)
J(1sn odwak(i AvJJ) kfrm-f rnr• I 4 (p
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own pro any If yes,what county? What Taxing District? H a as s deduction been requested If yes,state amount of deduction
other county property for
in Indiana? Yes - No current year? ❑
❑ Yes ❑No
A person is not entitled to th s 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 Data(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 aforeme•tioned property on date application is filed.
Sig -tore(o�,s ruff name) Date 1h,d a
Fr.- rent addligs• umber and sheer,dry ate,and ZIP code)
• 4, ` ' �i5 r\c\cj j k()I- t Ln lnl0
Person authorized by duly executed Power of Attolney or by IC 6-1.1-12-0.7 1 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.