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HomeMy WebLinkAboutMortgage_Fulton (2) •fin. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year i x FOR DEDUCTION FROM ASSESSED VALUATION At ,1. State Form 43709(R12/6-14) '; Y Prescribed by Department of Local Government Finance j ""E INSTRUCTIONS: To be filed in person or by mall. FormiWith: 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 is JUL (��J, U�7 County Auditor located on or before January 5 of the immediately succeeding calendar year. C�ecorder 2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county where the property is located during the twelve(12)months before March 31 of each year the deduction is sou pUDtT� See reverse side for additional instructions and qualifications. COUNTY Applicant(owner or contract b en see msbidions on reverse side) ^ Ct8$(1N Taxing District K umber I lea?!d ptio � Record number Page number tee I 1-1 -304 -©00.&33 -oa 15 25JD Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole Mardi 1,anent year March 1,arnent year • dati of application legal or equitable owner? 1` ❑ Yes ❑ No If no,what is his I her exact share of interest? If owned with someone other 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 ,'yt R Address of mortgagee or contract seller(number and street,crty,state,and ZIP code) Name of assignee or other owner or holder of mortgage Address of assignee(number and street,t Drawer NO /.5-' Does applicant own property in any If y this deduction been requested If yes,state amount of deduction other county / a operty for ❑ in Indiana? ❑Yes El No _ ( \ nt year? yes 0 N A person is not entitled to this deduct? Ca I'd NO. -tgage or contract indebtedness that is recorded in the county recorder's office(including any home• sr's office)that is the basis for the deduction. Deduction approved in the amount oft - 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. -- Signs re((oojTers ame) /�� � Date(month,day,year) / ,( �,Flu etsdrJt@ss of appfcigt(num6,r and s' -;reef,city,slue,a IP cyde) ^ (a y?e h r* /Person authorized by duly executed Power of Atto`meyyoor by IC 6-1 -0.77 (q(,/-` ,�i (`/-( hi 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.