HomeMy WebLinkAboutMortgage_Meny (15) 6.1.'") STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r. --r f, FOR DEDUCTION FROM ASSESSED VALUATION
+ `I" State Form 43709(R12/6-14) • T
‘' FQ. Prescribed by Department of Local Government Finance Yg
File Mark
INSTRUCTIONS:
To be filed in person or by mail. e�p 9 2015 Form filed with:
Firing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deducth hE sc4ght.
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. or ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Coun Ira: ,rr'n/rA7er my
where the property is located during the twelve(12)months before March 31 of vffittflhews..I. mono R
See reverse side for additional instructions and qualifications.
Appl /tnt((o�ownner{r oorrrcontra buyer-see res sonre erside)
iariyDistn'a Key nr/lega `� Record number Page number
d6,_/ s' -36)-3oa ooa . cSJGy -oa /. ao7O
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 x date of application legal or equitable owner?
/�{ y67C00 ❑ Yes ❑ No
If no,what is his I her exact share of interest? v I 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 mortga e r contract Ile
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)
C.' \'
n(l
Does applicant own property in any If yes,what county? What Taxing District? Has this de' \ ��tc
other county on pin `` \ ,�1
in Indiana? ❑Yes ❑No a- l r.1r1'v
A person is not entitled to this deduction unless the person has a balance on the person, l"�
lo g°
minty
recorder's office(including any home equity tine of credit that is recorded in the county rec 15'
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 a 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.
SSi
ignnat e/s full�naa(m/yn/� Date(month,day,year)
V FUJ of App' -nt numbe <I street,city,state,and ZIP code)
+C /00/9 5 %�,,ir:t c- 4-ve_-
Person authorized by duly executed Poc er 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.