HomeMy WebLinkAboutMortgage_Hoke (2) •^^n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
4,: FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
-'• State Form 43709(R12/6-14)
S „„ �' Prescribed by Department of Local Government Finance •
ILE
File Mark
INSTRUCTIONS: JUL 2 •• r
To be riled in person or by mail. 'F• '-•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 property . , 'u.• •uditor
located on or before January 5 of the immediately succeeding calendar year. �, —C jnnj;
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Coun Auditor •unty Recorder
P tl tY air UN1 _ i • :
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or co tract b yen-see re 'dons on reverse side) ^
Taxing District �ey number/legal description \I Record number Page number
Witt irk) Zco rV6-3(0- ytc - CO eD • 3t1 -t 5 aDj5 aatS
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?
0 f O ®Yes In
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
eal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
N -- Cr or contract seller a
►re -� D
Address of mortgagee•r••clued sells umber and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage --"—
Dralrcr NO /
Address of assignee(number and street,city,state,and ZIP code) -• (t
Does applicant own property in an If yes,what county? What Taxing District? Card NO �•,2 i deduction
other county
in Indiana? ❑Yes • ,
A person is not entitled to this deduction unless the person has a balance on the pers s in the county
recorder's office(including any home equity line of credit that is recorded in the county recoruo,.,_..
COUNTY AUDITOR .
Deduction approved in the amount of: -
20 20 20 20 20 20 20
Signature of County Auditor 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.
Signatur, •wner'sflan j-) Date(month,day,year)
/: _ 0, 1 g lA , •
resident address of applicant(number and street,city,state and ZIP code) V 4-ILA (�
F� t�e0a q Fork &on& VX
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$10,000.