HomeMy WebLinkAboutMortgage_Lloyd STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
1 FOR DEDUCTION FROM ASSESSED VALUATION g�
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a ° State Form 43709(R12/6-14) g)
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S = ' Prescribed by Department of Local Government Finance —
INSTRUCTIONS: File Mark
To be filed in person or by mail. AUG 2 I •-i. 'led 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 props , MI Co r• Auditor
located on or before January 5 of the immediately succeeding calendar year. l • in. i County Recorder•2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditorro(aLe ••np
where the property is located during the twelve(12)months before March 31 of each year the cledGCHdh�} N -
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-s-- -strictions on reverse side
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T. ' g Dis � \ Key number/legal description Record n er Page number
� - si s at, - t.%- a10-aDr) +oi �1q • oat / se3So/
ed value of real properly as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
March ,current year March 1,current year date of application legal or equitable owner?
all 3 9 to 1 42 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
btlieal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller
Address of mortgagee or contact seller(n ber and scree city,s e,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? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes teNo current year? ❑Yes ❑No
A person is not entitled to this 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 .
Deductic—_•—dh° •,ntnL,
2C i P., e�, 20 20 20 20
Signatu tit County Date(month,day,year)
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1 foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementione roperty on date application is filed.
Signature nee n e Dare(month,day,
W - •en address of app6ant number d street,dtY.state,and ZIP code) /� ���
I) ?O if 5 41/24717a1 (>acc //rrvess.'vr
Person authorized by duly executed Power ofAttoor by IC 6-1.1-12-0.7 Date(month,day,ye r)
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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.