HomeMy WebLinkAboutMortgage_Harpe (2) 0,). STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
• Ty
it, Stare Form 43709(R72/6-14) p Prescribed by Department of Local Government Finance (g�
File Mark
INSTRUCTIONS:
To be filed in person or by mail. JUL q� q 2015 Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sodgKt.
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. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Coont}> jBp Ity
where the property is located during the twelve(12)months before March 31 of @l1�1 V.4frP rig1t9�9D R
See reverse side for additional instructions and qualifications.
Taxi grtt(ownendf r�e ms'' io on side)
Tarring DisbiG `-/Key number/legal desi ription Record 1 Pagt<�b9r�3i-
z —19-jS- 303 coo5Y4/ 40 Jl CSj/
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?
/ 3 F 75 Co ❑ 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 midi,agee or contact seller
�n mama Lt%mntitt4ta'N
Address of mortgagee or contract seller(number and street,city,state,and 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? • / ed If yes,state amount of deduction
other county �)'a�\'C1" NO f• .•
in Indiana? ID Yes ❑No Vo
A person is not entitled to this deduction unless the person ha. �OQ-�� edness that is recorded in the county•recorder's office(including any home equity line of credit that i 7 /Yl ;is for the deduction.•Card NO.
Deduction approved in the amount of.
20 20 20 I zu I zu I '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 con s n"l/ Date(month,day,year)
//Z 4/_
F de address of applicant umber and street,city,state,and ZIP code)
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 S10,000.